_BiaCare_Catalog | Page 28

P: 866.931.0876
F: 866.931.0052

®

PLUS - 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

WEB: Scan QR code

CATALOG: Page 68 for standard size
PRODUCT INFORMATION
LEFT LEG

EMAIL: [e-mail]

OR visit BiaCare.com

Below Knee measuring instructions.

RIGHT LEG

ACCESSORIES (additional cost):

Size:

Size:

Length:

Length:

Silver Socks (pair) Qty:

Item #:

Item #:

Strap Extenders Qty:

Foot Size:

Foot Size:

Color:

Black

Beige

Note: if no color is selected, black will be shipped.

Color:

Cotton Socks (extra pair) Qty:

Black

Beige

SIZING CHART & ITEM NUMBERS
Bottom of
Patella

C
B
A

SMALL
24 - 34
19 - 29
15 - 24

COMPREFIT PLUS REGULAR

MEDIUM
29 - 39
24 - 34
16 - 25

X - LARGE XX - LARGE
50 - 60
43 - 53
36 - 46
39 - 50
27 - 37
28 - 38

LARGE
34 - 44
28 - 38
20 - 31

BLACK 1151 - BKR