Follow the steps to accurately fill out the Transtibial SiliconeGel Custom Liner From Measurement Form

1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin by entering your customer number in the designated field to identify your record.
3. Provide your contact information, including your name, email address, and phone number, ensuring that the information is accurate for communication purposes.
4. Indicate the date on which you are filling out the form to track the timing of your request.
5. If your shipping address differs from your customer address, fill in the additional shipping address fields, including company name, street, postal code, and city.
6. Enter your patient ID in the respective field to link the measurement to the correct individual.
7. Specify the affected side by selecting either 'Left' or 'Right' along with the desired wall thickness, choosing from the available options of 4 mm or 5 mm.
8. Indicate the distal residual limb end thickness as specified by your healthcare professional.
9. Select whether this is a new order or a re-order by checking the appropriate box and providing the previous measurement line number if applicable.
10. Choose the type of SiliconeGel liner required from the provided options, indicating any additional features such as textile coating or connector types.
11. Fill in the wall thickness tolerances if applicable and specify details for the extension strip and number of matrix fingers as needed.
12. Select your preferred skin and textile colors from the available choices.
13. Use the comments section to provide any additional information or requests relevant to your order.
14. Review all entered information for accuracy before submitting your form.
15. Upon completion, save changes to your form, download it for your records, print a copy, or share it with the relevant parties.

Complete the document online to ensure you receive your custom liner efficiently and promptly.