Get Breg Custom Knee Brace Order Form

Filling out the Breg Custom Knee Brace Order Form online is a straightforward process that allows users to customize their knee braces effectively. This guide provides detailed instructions to assist you in completing the form accurately.

Follow the steps to successfully complete your order form

1. Click the ‘Get Form’ button to access the order form and open it in your preferred editor.
2. In the 'Bill To' section, fill in your billing information, including customer number, purchase order number, contact name, telephone number, and address.
3. If the shipping address is different, complete the 'Ship To' section with the recipient's name and shipping address.
4. Under 'Patient Information,' provide details such as the patient's name, age, weight, height, and preferred sex.
5. Fill out the 'Leg Measurements' section by measuring the thigh and calf circumferences. Additionally, indicate the knee offset, extension, and flexion settings using the provided options.
6. Select the appropriate 'Fusion Brace Information' or 'X2K Brace Information' based on your needs, including any additional options like standard or adjustable hinges.
7. In the 'Notes/Special Instructions' field, add any specific requests or further instructions relevant to your order.
8. Choose any accessories you wish to include in your order from the available options.
9. After completing the form, review all entered information for accuracy.
10. Finally, save your changes, download a copy of the form, or print and share it as needed.

Complete your Breg Custom Knee Brace Order Form online today to ensure a timely and accurate order.