Checklist Before Closing or Retiring from Practice

9. Do you suffer from frequent/severe ankle/knee sprains? YES NO . 10. Do you wear or have you been advised to wear orthotics in your shoes? YES NO. 11. Do you wear any brace, tape or other appliance for an orthopedic problem or as protection? YES NO. 13. Please list any orthopedic problems/conditions you have that are not covered in this section. ................
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