Order AK by Measurements
AK by Measurements Online Ordering To ensure the best results, please fill out completely. Red * indicates required fields
CONTACT INFORMATION
* P.O. # * Company/Branch:
Address: State: Zip:
City: * Shipping Method: * Phone #:
* E-mail:
* Contact Name:
PATIENT INFORMATION
* Sex: Patient Name:
* Activity Level: *
TEMPLATES MEASUREMENTS DISTAL END
* Choose One : My Custom template:
M-L of distal end:
Knee disarticulation
* Length: Flexion:
Adduction:
Reduced measurements for suction: Level
*
0"
2" 4"
6"
OTHER INFORMATION
8"
10"
12"
*All measurements in inches
**We fabricate our products from the measurements you provide, to the specifications requested, and in accordance with generally accepted O & P industry practices. We rely entirely upon the judgment and evaluation of the qualified professional seeing the patient to ensure the fit and function of our products and will make every effort to rectify any situation that may arise.
SPECIAL INSTRUCTIONS
110 Industrial Road Fulton, MO 65251 800.470.1188
