How can we help you?
Once you fill in this form and click Submit, you will get a Case Number. We will track the status of your case and resolve it to your satisfaction.
Please identify yourself for us to serve you better
Provider/Practitioner
Patient/End User
Account Manager/Representative
Field Label identified by asterisk (*) is required
Account Number
Contact Name*
Email*
Phone*
Order#
(Please enter Dr.Comfort Order#)
Case Details *
(Max 500 char)
Attachment Name
(E.g. Shoe Photo or Invoice Copy etc. Max 30 char)
Attachment
(Images, Picture, PDF document. Max 5MB Size)
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