CLICK HERE TO PRINT FAX ORDER FORM
BEBsport Measurement Form for Transfemoral Amputees
THE LUK !!
UNILATERAL BILATERAL
A - CIRCUMFERENCE 2"FROM DISTAL END
B - LENGTH FROM GROIN TO DISTAL END
C - LENGTH FROM WAIST TO DISTAL END
D - CIRCUMFERENCE FOR HIP
E - CIRCUMFERENCE FOR WAIST
SPECIFY WITH Ö MARK
LEFT
RIGHT
BILATERAL
LENGTH
Bikini
Boxer
Biker
SPECIFY LOCATION OF FLY : LEFT SIDE
RIGHT SIDE
NO FLY
PATIENT NAME______________________________
PHONE______________________________________
ADDRESS____________________________________
E-MAIL______________________________________
When ordering from this web site the cost is $150.00 per garment plus shipping and handling
Fax order to Genuine Care Rehab at 405-606-5618
Copyright(c) 2011 Bebsports. All rights reserved.