LEGASSIST - THIGH HIGH
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 63 for LegAssist™
Thigh High 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
Right
OPTIONAL:
FOAM:
Regular (flat foam)
Custom MedaBoot™ (additional charge)
BiaCare.com
•
Advanced (WaveFoam™)
Hip Attachment (additional charge)
P: 866.931.0876
•
F: 866.931.0052
Straps over knee
44