BiaCare Product Catalog | Page 29

ORDER FORM

[e-mail] • P: 866.931.0876 • F: 866.931.0052

PO#:

Contact:

Company:

Phone:

Patient Name:

Date:
Age:

Ht:

Wt:

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

PRODUCT INFORMATION
LEFT LEG
SIZE:

OVERSLEEVE (included):

RIGHT LEG

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

SIZE:

LENGTH:

LENGTH:

ITEM #:

ITEM #:

Black

Pink

Navy

Tie-Dye

Leopard

Blue Horizon

SIZING & ITEM NUMBERS
Measuring instructions on page 85
MEDIUM
37 - 47
34 - 44
29 - 39
21 - 30

LARGE
42 - 52
39 - 49
33 - 43
25 - 36

XLARGE
51 - 61
48 - 58
41 - 51
32 - 42

XXLARGE
58 - 68
55 - 65
44 - 55
33 - 43

REG 2631 - BKR

2632 - BKR

2633 - BKR

2634 - BKR

2635 - BKR

TALL 2631 - BKT

2632 - BKT

2633 - BKT

2634 - BKT

2635 - BKT

C1
C
B
A

SMALL
32 - 42
29 - 39
24 - 34
20 - 29

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