THERABra
P: 866.931.0876
F: 866.931.0052
[email protected]
™
ORDER FORM
PO#:
Date:
Company:
Phone:
Contact Name:
Patient Name:
Sex:
Age:
Ht:
Wt:
Bill-To Name & Address:
Ship-To Name & Address:
PRODUCT INFORMATION
CUP SIZE:
A/B
C/D
DD/E
LENGTH:
PETITE
REGULAR
It is recommended that if the patient is 5’3”
or shorter in height, select Petite Length.
ITEM #:
CHIPPAD™ (additional cost):
Bra: QUARTER
Bra: FULL
Bra: HALF
Other (see pg. 43):
MEASURING INSTRUCTIONS
Step 1
Step 2
Step 3
Step 4
BAND SIZE:
To determine the band size, take
the larger measurement of Steps
1 & 2 and round odd numbers up.
Measure the circumference in
inches directly under the bust
(where a regular bra sits).
Move 2” - 3” down towards the
rib cage from Step 1 and measure circumference in inches.
Step 1:
BUST:
Measure circumference
at the fullest part of bust.
Step 2:
SIZING CHART & ITEM NUMBERS
A/B
BAND SIZE
PETITE
Step 5
C/D
BAND SIZE
BUST:
BAND SIZE:
MEDIUM
LARGE
XLARGE
XXLARGE
28 / 30
36 / 38
40 / 42
32 / 34
44 / 46
2901-AB-P 2902-AB-P 2903-AB-P 2904-AB-P 2905-AB-P
REGULAR 2901-AB-R 2902-AB-R 2903-AB-R 2904-AB-R 2905-AB-R
To determine the cup size, subtract the Bust from the
Band Size. Use the difference in the chart below to
select cup size.
-
SMALL
PETITE
= CUP SIZE:
2” or less A/B
2” - 4”
C/D
4” - 6”
DD/E
SMALL
MEDIUM
LARGE
XLARGE XXLARGE
28 / 30
36 / 38
40 / 42
44 / 46
32 / 34
2901-CD-P 2902-CD-P 2903-CD-P 2904-CD-P 2905-CD-P
REGULAR 2901-CD-R 2902-CD-R 2903-CD-R 2904-CD-R 2905-CD-R
DD/E
MEDIUM
LARGE
XLARGE XXLARGE
BAND SIZE SMALL
28 / 30
36 / 38
40 / 42
44 / 46
32 / 34
PETITE 2901-DDE-P 2902-DDE-P 2903-DDE-P 2904-DDE-P 2905-DDE-P
REGULAR 2901-DDE-R 2902-DDE-R 2903-DDE-R 2904-DDE-R 2905-DDE-R
38