ORDER FORM
Sales@BiaCare.com • P: 866.931.0876 • F: 866.931.0052
PO#:
Company:
Phone:
Contact:
Date:
Patient Name:
Age:
Ht:
Wt:
Bill-To Name & Address:
Ship-To Name & Address:
PRODUCT INFORMATION
SIZE
SMALL
MEDIUM
LARGE
XLARGE
ITEM NUMBER
SIZING & ITEM NUMBERS
HEAD - measure circumference starting at the top of the head down
to under the chin, back to top of head.
NECK - measure circumference at largest part of neck.
HEAD
NECK
SMALL
46 - 56
28 - 33
MEDIUM
52 - 62
33 - 38
LARGE
56 - 66
38 - 43
XLARGE
58 - 68
43 - 58
2231 - NM 2232 - NM 2233 - NM 2234 - NM
17