Technomed Custom Made Pressure garments

Order Form for pressure garments Torso, Foot.
Note:- Please fill the details as per the labels marked in the corresponding image. i.e.L1, R1 etc.
(ALL MEASUREMENTS TO BE TAKEN IN CENTIMETRE'S)

For Torso Data

L1 :		R1 :
L2 :		R2 :
L3 :		R3 :
L4 :		C1 :
L5 :		C2 :
C3 :
CL4 :		CR4 :
CL5 :		CR5 :
CL6 :		CR6 :
CL7 :		CR7 :
CL8 :		CR8 :
CL9 :		CR9 :
CL10 :		CR10 :
CL11 :		CR11 :
CL12 :		CR12 :
CL13 :		CR13 :
MIDL :
ZP1 :		ZP2 :
ZP3 :		ZP4 :
ZP5 :		ZP6 :
left	Foot Data		right
LF1:		RF1:
LF2:		RF2:
LF3:		RF3:
LF4:		RF4:
LF5:		RF5:

Note:- All the fields below are required to be filled. ( Your order form will not be submitted if left blank)

NAME :
E-MAIL :
ADDRESS :
PHONE :
ADDITIONAL INFORMATION :

reference diagram torso, foot

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