_BiaCare_Catalog | Page 20

P: 866.931.0876
F: 866.931.0052

- BELOW KNEE

Measure & Order Form

[e-mail]

PO#:

Date:

Company:
Phone:

Contact Name:
Patient:

Sex:

Age:

Ht:

Wt:

Bill-To Name & Address:
Ship-To Name & Address:

MEASURING INSTRUCTION OPTIONS
CATALOG: Page 68 for standard size

PRODUCT INFORMATION
LEFT LEG

EMAIL: [e-mail]

WEB: Scan QR code

Below Knee measuring instructions.

OR visit BiaCare.com

RIGHT LEG

Size:

Item #:

Custom Size*

Pink

Leopard

Navy

Length:

Item #:

Black

Size:

Length:

OVERSLEEVE (check one):
Tie-Dye

Purple Paisley

Note: If no color is specified, a black OverSleeve™
will be included.

Custom Size*

*Use the measuring form on page 28 if ordering a custom size ChipSleeve™ - BK.

SIZING CHART & ITEM NUMBERS
Bottom of
Patella

C1
C
B

A

LENGTH (CM)
REG: 28 - 36
TALL: 36 - 42

BiaCare.com

•

CHIPSLEEVE - BK

X - LARGE XX - LARGE
51 - 61
58 - 68

SMALL
32 - 42

MEDIUM
37 - 47

LARGE
42 - 52

29 - 39

34 - 44

39 - 49

48 - 58

55 - 65

24 - 34

29 - 39

33 - 43

41 - 51

44 - 55

20 - 29

21 - 30

25 - 36

32 - 42

33 - 43

REG 2631 - BKR 2632 - BKR 2633 - BKR 2634 - BKR 2635 - BKR

TALL 2631 - BKT 2632 - BKT 2633 - BKT 2634 - BKT 2635 - BKT

P: 866.931.0876

•

F: 866.931.0052

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