P: 866.931.0876
F: 866.931.0052
[email protected]
- ARM
ORDER FORM
PO#:
Date:
Company:
Phone:
Contact Name:
Patient Name:
Sex:
Age:
Ht:
Wt:
Bill-To Name & Address:
Ship-To Name & Address:
PRODUCT INFORMATION
ARM:
Left
HAND OPTIONS (see page 42)
Right
Check One:
SIZE:
MedaHand™ (Included)
MedaGlove™ (Upcharge)
Dorsal Pocket Glove (Upcharge)
LENGTH:
Hand OverSleeve (Upcharge)
ITEM #:
Size:
Glove OverSleeve (Upcharge)
Item #:
SIZING CHART & ITEM NUMBERS
MEDAFIT - ARM
C
B1
B
A
Circumference at
AXILLA
Circumference at
Circumference at
LEFT
MID BICEP
RIGHT
ELBOW
LENGTH
SHORT:
38 - 43
REGULAR:
43 - 48
LONG:
48 - 53
SHORT
SMALL
MEDIUM
LARGE
X-LARGE
22 - 30
26 - 34
35 - 44
20 - 27
24 - 31
30 - 39
28 - 35
14 - 17
15 - 18
16 - 19
18 - 20
23 - 32
28 - 37
33 - 43
39 - 49
32 - 39
1201 - SHO - L 1202 - SHO - L 1203 - SHO - L 1204 - SHO - L
REGULAR 1201 - REG - L 1202 - REG - L 1203 - REG - L 1204 - REG - L
LONG
1201 - LNG - L 1202 - LNG - L 1203 - LNG - L 1204 - LNG - L
SHORT
1201 - SHO - R 1202 - SHO - R 1203 - SHO - R 1204 - SHO - R
REGULAR 1201 - REG - R 1202 - REG - R 1203 - REG - R 1204 - REG - R
LONG
1201 - LNG - R 1202 - LNG - R 1203 - LNG - R 1204 - LNG - R
HAND SIZING CHART
Circumference at
WRIST
E (Palm)
A (Wrist)
SMALL
15 - 19
14 - 20
RIGHT 1201 - H - R
LEFT 1201 - H - L
19 - 22
16 - 22
LARGE
22 - 26
18 - 24
X-LARGE
1202 - H - R
1202 - H - L
1203 - H - R
1203 - H - L
1204 - H - R
1204 - H - L
MEDIUM
26 - 29
20 - 26
8