Referral Form

You must enter a validated medical Referral Code to submit an order and get a 10% discount.  A Referral Code is typically issued by the Practitioner recommending littleSTEPS.  If you did not receive a Referral Code download the attached form and have it signed by a medical practitioner (MD, DPM, Chiro, Physical Therapist, etc.)  This is typically accomplished via email and should not require an office visit. 

Have the practitioner sign and email you the completed form  Forward the signed form to

You will be sent a Referral Code by email which will also discount the online price by 10% when submitted with the order. Retain the Referral Code for future orders for upsizing to receive a 10% discount for those orders.  

For questions call 203-725-6179.