Fort Collins Medical Supplies

Request Your Custom Orthotic Brace

Please complete the form below to schedule your fitting or order your orthotic device. Our specialists will review your information and contact you shortly.

Full Name *

Date of Birth *

Phone Number *

Email Address *

Injury or Condition *

Current Activity Level *

Insurance Information

Prescription Status *

Yes No Need Assistance

Preferred Appointment / Pickup Method *

Additional Notes / Questions

Consent Form is Signed *

Assignment of Benefits *

All information is secure and HIPAA-compliant.

Why Choose In-Home Orthotics?

Personalized measurement & fitting
Avoid multiple clinic visits
Covered by most insurance plans

Your Local Custom Fit Experts

At Fort Collins Medical Supplies, our experienced orthotic specialists take the time to understand your needs and provide comfortable, precise fittings for braces, supports, and orthopedic footwear — all with a friendly, community-first approach.