Follow the steps to fill out the Ottobock Custom Liner Order Form

1. Press the ‘Get Form’ button to access the order form and open it within your preferred digital document management tool.
2. Begin by entering your account number and purchase order number (PO No.) if applicable.
3. In the 'Ship To' section, provide the name and address where the liner should be delivered. If this address differs from the billing address, fill out the 'Bill To' section accordingly.
4. Ensure you input the required phone number for a contact person and, if necessary, a fax number.
5. Select your preferred shipping option from the available choices: Ground, 2-Day, Next Day a.m., Next Day p.m., or Other.
6. Clearly enter the patient's first and last name in the Patient Information section, as the custom liners will be imprinted with this information.
7. If applicable, indicate whether the measurements are for the left or right transtibial or transfemoral by checking the appropriate boxes.
8. Provide the necessary limb measurements, ensuring to follow any special instructions regarding limb length and casting angles.
9. Select the type of custom liner you wish to order, specifying whether it is a Custom Harmony® Liner or a Custom Urethane Liner and choosing your desired options for wall thickness, exterior cover, and locking mechanism.
10. Add any special requests in the designated field to ensure that your order is tailored to your specific needs.
11. Review all entered information carefully to confirm that it is complete and accurate as missing information may delay your order.
12. Once you have completed filling out the form, save your changes and choose to download, print, or share the form as needed.

Complete your Ottobock Custom Liner Order Form online today!