Get Juzo Custom Order Form

Filling out the Juzo Custom Order Form online is a straightforward process that ensures accuracy in your custom measurements for arm sleeves. This guide will walk you through each section of the form to help you complete it efficiently and effectively.

Follow the steps to complete the Juzo Custom Order Form effortlessly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your account information. Fill in the account number, date, account name, contact details, phone number, fax number, patient ID, and PO number.
3. Provide prescribing physician details in the designated field.
4. In the order information section, indicate the quantity and specification of the extremity (either right or left). Select if the piece will be worn with a gauntlet.
5. Record all measurements in centimeters. You will need to enter circumference measurements for both the left and right arms.
6. Select the desired compression level from the options provided: 18-21 mmHg, 23-32 mmHg, or 34-46 mmHg.
7. Choose the model for Juzo Strong, opting for either Juzo Strong or Juzo Strong Silver.
8. Pick the style you prefer, including options for CG (standard with a slant top and elbow dart), silicone border, or straight top.
9. For Juzo Helastic, indicate the model and select the preferred style.
10. If you have any special requests, specify them in the provided space.
11. Review all entered information for accuracy, then save your changes. You may choose to download, print, or share the completed form.

Complete the Juzo Custom Order Form online today to ensure your measurements are recorded accurately.