*Street Address:

Adress Line 2

*Postal/Zip Code

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By filling out this questionnaire, you are agreeing to have this information displayed on our website as part of our practitioner directory for clubfoot families. We ask that you answer honestly and earnestly, and we have full discretion to remove your listing from our directory if families advise us that you are providing subpar treatments for their children.

*Street Address:

Do you use the Ponseti Method for clubfoot treatment? If yes, when were you trained to use it?

No
Sometimes
Yes (If so, when were you trained?)

Approximately what percentage of your total patients are clubfoot patients?

What is your Percentage? 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Do you have designated days/times for "Clubfoot Clinics"?

No
Yes (If so, what days/times?)

What type of casts do you use for initial treatment (infants):

Soft-Roll Fiberglass
Plaster

Approximately what percentage of your clubfoot patients experience relapse?

What is your Percentage? 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Age you typically advise patients brace until:

1 year old
2 years old
3 years old
4 years old
5 years old or older

Who does the casting in your office?

Casting Tech/Nurse
The Doctor
It depends on availability

How has your experience been recognizing and treating atypical/complex clubfoot?

Do you primarily use general or local anesthesia?

General Anesthesia
Local Anesthesia
Preference of family

If you have any questions and/or concerns, please email us at Hello@clubfootcares.com