Registration Form for Patients

Register Your RevoFit™ Product Why do we want you to register your RevoFit system with us?

Because we want you to get the maximum benefit of adjustability and that means knowing how to maintain your RevoFit system. It may be made of many moving parts but if you pay attention to how the lace is wearing, and check it at regular 6-month intervals, you’ll be unstoppable!

With this registration, you’ll get automatic email reminders for your next 6-month and 12-month lace replacement visits. We do not share your email with anyone beyond our walls.

As a thank you for taking the time to do this, you'll receive a $10 Amazon card that will be emailed to you once you submit the form below.

Your Name*
First Last
Your Email*
Your Country*
Select your country
Who is your practitioner?*
Practitioner First Name Practitioner Last Name
What is the name of your practitioner's business?*
(HIDDEN/YEAR ONLY) When did you get your RevoFit2 system built into your socket?*
Approximately when did you get your RevoFit2 system built into your socket?*
Please write out the month and year in full.
Month Year
We would love to see your new socket! Upload a picture:
Accepted file types: jpg, gif, png, pdf.
By submitting this form you are giving Click Medical consent to use your image.
Email
This field is for validation purposes and should be left unchanged.