BiaCare Product Catalog | Page 31

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

F
E
D

SMALL

MEDIUM

LARGE

XLARGE

48 - 58
43 - 53
38 - 48

56 - 66
51 - 61
46 - 56

64 - 74
58 - 68
53 - 63

74 - 84
68 - 78
63 - 73

C1
C
B
A

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

37 - 47
34 - 44
29 - 39
21 - 30

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

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

LEFT

SHORT 2631 - THS - L 2632 - THS - L 2633 - THS - L 2634 - THS - L
REG 2631 - THR - L 2632 - THR - L 2633 - THR - L 2634 - THR - L
TALL 2631 - THT - L 2632 - THT - L 2633 - THT - L 2634 - THT - L

RIGHT

SHORT 2631 - THS - R 2632 - THS - R 2633 - THS - R 2634 - THS - R
REG 2631 - THR - R 2632 - THR - R 2633 - THR - R 2634 - THR - R
TALL 2631 - THT - R 2632 - THT - R 2633 - THT - R 2634 - THT - R

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