Order Form Header

The header portion of our orthosis order form contains important doctor and patient identification information. Dr Name: Use the doctor’s name, and the name of the clinic when applicable. Date: This is important for the lab and your office as a point of reference when tracking an order. Address: This is especially important if you have more than one office. Always indicate which office your order is to be shipped and / or billed to. Phone: Filling in this blank will expedite your order when phone consultation is a requirement. Patient’s name: This is imperative to accurately complete the order. Age, Sex, Weight, Activity: This information will enable us to share ideas and suggestions with you if we see a possible discrepancy in your order regarding the type of orthoses or material selection.