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Learn more about how Walkasins® may help you.

Balance. Mobility. Confidence.

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To learn more about Walkasins lower limb sensory prosthesis, please fill out the following form.

Name*

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Street Address

City

State*

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Email*

Phone*

Personal Information:*

I am (check one)*:

a patient with Peripheral Neuropathy

contacting on behalf of a friend or family member

other

Other (personal information)

To learn more about Walkasins lower limb sensory prosthesis, please fill out the following form.

Peripheral Neuropathy symptoms I experience include (select all that apply):

Numbness and reduced sensation in feet

Difficulty with balance and walking

Tripping and/or prior falls

Reduced or limited mobility

Other

Peripheral Nueropathy symptoms experienced (other)

I receive medical benefits from (select all that apply):

Veteran’s Administration

Tricare

Medicare

Medicaid

Private insurance

Other

Source of medical benefits (other)

Let us know how we can help you:

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Our
Product
Patients
Healthcare
Professionals
About Us
News & Events
Contact

RxFunction, Inc.
7576 Market Place Drive
Eden Prairie, MN 55344-3636
888.382.3518
info@rxfunction.com

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