Technomed Custom Made Pressure garments

Order Form (For pressure garment of Female Patients)
Note:- Please fill the details for pressure garment as per the labels marked in the corresponding image. i.e.C1, C2 etc.
(ALL MEASUREMENTS TO BE TAKEN IN CENTIMETRES)

(Female Patients)

   C1:       C2:
  C3:        C4:
BRA SIZE IN CMS:
 

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 for pressure garment of female patients

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