Get Rebel Reliever Order Form

Filling out the Rebel Reliever Order Form online can be a straightforward process with the right guidance. This comprehensive guide will walk you through each section of the form, ensuring you provide all necessary information accurately and efficiently.

Follow the steps to complete the online order form seamlessly.

1. Press the ‘Get Form’ button to access the Rebel Reliever Order Form and open it in your online editor.
2. In the 'Ordered by' section, enter your details, including your name and phone number. Ensure the phone number is accurate for any follow-up communication.
3. Complete the 'BILLING' section by entering the P.O. number and Townsend account number, followed by the billing and shipping addresses. Make sure to provide the correct postal information, including city, state, zip code, and country.
4. Select your shipping preference from the options provided: ground, 2-day PM, 2-day AM, next day PM, or next day AM. Note that if no preference is indicated, the order will default to 2-day PM shipping.
5. Fill in the patient details by entering the patient's last name, first name, age, height, and weight. These details will help determine the appropriate bracing solution.
6. Choose the compartment that is most suitable: medial, lateral, or universal, based on the patient's needs.
7. Specify the leg side by selecting either left or right, then select the size options based on the provided measurement guide.
8. Indicate any additional features or color preferences for the brace, which may incur extra charges. If custom assembly is required, include the leg measurements in the designated area.
9. Review all filled-out sections for accuracy. Make any necessary corrections to ensure all information is correct.
10. Once you have completed all sections, save your changes, and choose to download, print, or share the completed form as needed.

Begin completing your Rebel Reliever Order Form online today for a smooth and efficient process.