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Welcome To Happy Walk Diagnose Center
Please fill this form for Medical evaluation of your foot. Our Certified Podiatrist and orthopedist will provide a proper solution for you
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1
Do you have Diabetes ?
*
This field is required.
It will help us to understand you better
YES
NO
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2
Select your Pain Areas ( Left Side )
*
This field is required.
Select the pain you have
Heel Pain
Ankle Pain
Achilles pain
Forefoot pain
Arch Pain
General foot pain
None of these
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3
Select your Pain Areas ( Right Side )
*
This field is required.
Select the pain you have
Heel Pain
Ankle Pain
Achilles pain
Forefoot pain
Arch Pain
General foot pain
None of these
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4
Do you have these problems ?
*
This field is required.
Knee Pain
Back Pain
None of these
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5
How long have you been experiencing these pain?
*
This field is required.
Few days
More than a week
More than a month
More than six months
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6
Let us understand your pain better
*
This field is required.
Please Select
continuous pain
While performing activities
Please Select
Please Select
continuous pain
While performing activities
Do you have continuous pain or only while performing activities?
Please Select
Yes
No
Please Select
Please Select
Yes
No
Do you have any sleep disturbance due to pain?
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7
Are you under any medication for such pain right now?
*
This field is required.
YES
NO
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8
Get ready to take photos of your feet
You are required to take multiple images of your feet to help us diagnose better
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9
Step 1: How to take Arch side picture (Left side)
Stand on ground, put one feet ahead and stretch your toes up and click photo from arch side(Gap side)
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10
Step 1: Upload Photo - Arch Side Left Foot
Please stretch your left foot
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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11
Step 2: How to take Arch side picture (Right side)
Stand on ground, put one feet ahead and stretch your toes up and click photo from arch side(Gap side)
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12
Step 2: Upload Photo - Arch Side Right Foot
Please stretch your foot (Right SIDE)
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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13
Step 3: How to take Bottom foot picture (Left)
Sit on a char, put your phone parallel to feet and click photo
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14
Step 3: Upload Photo - Left Foot Bottom Side
Sit on a char, put your phone parallel to feet and click photo
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
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15
Step 4: How to take Bottom foot picture (Right)
Sit on a char, put your phone parallel to feet and click photo
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16
Step 4: Upload Photo - Right Foot Bottom Side
Sit on a char, put your phone parallel to feet and click photo
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
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17
Step 5: How to click Back Side of both feet
Stand on ground. Fold your pants till knee. Keep your foot
shoulder distance
apart, and take picture from back.
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18
Step 5: Upload Back
You can ask your friend to take a picture or put phone on ground and put a timer. NOTE: KEEP PHONE ALMOST GROUND LEVEL
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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19
Enter Your Details
*
This field is required.
It will Help us to Understand you Better
Name
Age (in Years)
Please Select
Male
Female
Other
Please Select
Please Select
Male
Female
Other
Gender
Weight (Kg)
Please Select
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6
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6.11
7
Please Select
Please Select
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4.10
4.11
5
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6
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7
Height (Ft.Inch)
Your City
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20
Your Contact Details
*
This field is required.
It will help us to share you the updates through mail and whatsapp
Please enter your phone
Please enter your email
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21
What is your Shoe Size
Please Select
UK/IND
US
EURO
Please Select
Please Select
UK/IND
US
EURO
Size Unit
Shoe Size
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22
Describe your pain or problem
Have you been diagnosed with a specific problem by doctor. Describe your injury history if any
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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23
Show us your manner of walking
Place your camera on ground or ask your friend to make a video. Set a timer. Start walking in front 10 steps and then come back 10 steps. If comfortable use shorts or fold your pants till knees.
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24
File Upload
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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