BiaCare Product Catalog | Page 22

CompreFLEX P: 866.931.0876 F: 866.931.0052 [email protected] ™ - BK ORDER FORM PO#: Date: Company: Phone: Contact Name: Patient Name: Sex: Age: Ht: Wt: Bill-To Name & Address: Ship-To Name & Address: PRODUCT INFORMATION LEFT LEG RIGHT LEG ACCESSORIES (additional cost): SIZE: SIZE: Cotton Socks (extra pair) Qty: LENGTH: LENGTH: Silver Socks (pair) Qty: ITEM #: ITEM #: Strap Extenders Qty: COMPREBOOT SIZE: COMPREBOOT SIZE: SIZING CHART & ITEM NUMBERS COMPREFLEX - BK C1 C B A Bottom of Patella SMALL MEDIUM LARGE 29 - 39 34 - 44 24 - 34 16 - 26 29 - 39 REGULAR 1401 - BKR TALL X-LARGE XX-LARGE 46 - 56 54 - 64 46 - 56 54 - 64 29 - 39 40 - 50 34 - 44 39 - 49 44 - 55 21 - 30 26 - 36 31 - 41 36 - 46 34 - 44 40 - 50 1402 - BKR 1403 - BKR 1404 - BKR 1405 - BKR 1401 - BKT 1402 - BKT LENGTH (CM) 1403 - BKT 1404 - BKT 1405 - BKT COMPREBOOT REG: 30 - 34 REG: 30 - 36 TALL: 34 42 TALL: 36 -- 42 SMALL REGULAR I 28 - 36 J 22 - 26 K 14 - 18 LONG 28 - 36 22 - 26 19 - 23 MED/LARGE REGULAR 39 max 30 max 18 - 20 LONG 39 max 30 max 23 - 25 XL/XXL REGULAR 44 max 33 max 20 - 22 LONG 44 max 33 max 25 - 27 & 18