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Prosthetic Fashions>Order Form
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CLICK HERE TO PRINT FAX ORDER FORM BEBsport Measurement Form for Transfemoral Amputees
THE LUK !! UNILATERAL BILATERAL
A - CIRCUMFERENCE 2"FROM DISTAL END B - LENGTH FROM GROIN TO DISTAL END C - LENGTH FROM WAIST TO DISTAL END D - CIRCUMFERENCE FOR HIP E - CIRCUMFERENCE FOR WAIST SPECIFY WITH Ö MARK
LENGTH
PATIENT NAME______________________________ PHONE______________________________________ ADDRESS____________________________________ E-MAIL______________________________________ When ordering from this web site the cost is $65.00 per garment plus shipping and handling Fax order to Genuine Care Rehab at 405-749-0284 |
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