LEGASSIST - BK with SHELF
P: 866.931.0876
F: 866.931.0052
Measure & Order Form
Sales@BiaCare.com
PO#:
Date:
Company:
Phone:
Contact Name:
Patient:
Sex:
Age:
Ht:
Wt:
Bill-To Name & Address:
Ship-To Name & Address:
MEASURING INSTRUCTION OPTIONS
CATALOG: Page 61 for LegAssist™
Below Knee measuring instructions.
WEB: Scan QR code
EMAIL: Sales@BiaCare.com
OR visit BiaCare.com
I have read and understand the written measuring
instructions for the LegAssist™ custom garment.
I have watched the online instruction
video for the LegAssist™ custom garment.
Photos have been emailed to:
Sales@BiaCare.com
Orders will not be accepted without all three boxes being checked. Your assistance in this will help the patient receive a
better product in less time.
PRODUCT OPTIONS
LEG:
Left
FOOT OPTIONS:
FOAM:
Right
Regular (flat foam)
Advanced (WaveFoam™)
CompreBoot™ PLUS (included - see pg. 53 for sizing)
L en g t h s Ab ov e /
0
Custom MedaBoot™ (additional charge)
= Locations measured along
lateral aspect of leg.
Follow the contour of the limb
on all measurements
Circumferences:
Bottom of Patella
L e n g t h s Be low /
0
*
BiaCare.com
•
P: 866.931.0876
*
•
F: 866.931.0052
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