Technomed Custom Made Pressure garments

Order Form
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 CENTIMETRES)

For Torso Data

L1 :     R1 :
L2 :     R2 :
L3 :     R3 :
L4 :     R4 :
L5 :     R5 :
L6 :     R6 :
L7 :     R7 :
L8 :     R8 :
L9 :     R9 : L10:    R10: L11:    R11: L12:    R12: L13:    R13: L14:    R14: C1:       C2:
             C3:  
CR4: CL4:
  Z1 :    Z2 :
 

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 :

      

Diagram Torso Data
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