Referral - Officiële website Verbandschoenen

Upload your referral letter

Attention! Complete this form only if you have a valid referral

We will use this e-mail address to update you on the status of your order.

Firstname(Required)

Lastname(Required)

Email(Required)

Enter the address where we should send the order to

Shipping details(Required)

Upload the referral you received from your GP.

Referral letter(Required)

Drop files here or

Max. file size: 512 MB.

Attention! Complete this form only if you have a referral

Model(Required)

Paris 1

Paris 2

Attention! Complete this form only if you have a referral

Size(Required)