Get Juxtafit Leg Referral Form - Medi Uk Ltd.

Filling out the Juxtafit Leg Referral Form online is a straightforward process designed to ensure accurate patient referrals for essential leg products. This guide provides step-by-step instructions to help you complete the form efficiently and correctly.

Follow the steps to accurately complete the Juxtafit Leg Referral Form.

1. Click the ‘Get Form’ button to access the Juxtafit Leg Referral Form and open it in your document editor.
2. Begin by entering the patient's name in the designated field. Be sure to type the full name clearly for proper identification.
3. In the ‘Measured by’ section, input the name of the individual who measured the patient's leg for the referral. This may be a healthcare professional or technician.
4. Provide the patient's contact telephone number to ensure easier communication if there are any questions regarding the referral.
5. Select the appropriate product based on the patient's needs from the provided product list. Make sure to note the specific size, circumference (in centimeters), and PIP code corresponding to the selected product.
6. For the Juxtafit Essentials Upper Leg, indicate whether it is for the right or left leg and specify if you need a standard or long length. Fill in size and measurement details accurately as outlined in the chart.
7. Repeat the process for the Juxtafit Lower Leg and Ankle Foot Wrap products, selecting the correct sizes and measurements for each.
8. Once all fields are completed, review the form thoroughly for any errors or missing information to ensure accuracy before final submission.
9. Finally, save your changes. You can also download, print, or share the completed form as needed.

Complete your paperwork by filling out the Juxtafit Leg Referral Form online today.