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  • Custom Silicone Liners Order Form - Otto Bock

Get Custom Silicone Liners Order Form - Otto Bock

CUSTOM SILICONE ? LINERS ORDER FORM For Clinical Use Only Bill To: Ship To: Company Name: Company Name: City: City: Address: Address: State/Prov: State/Prov: Phone: Phone: Fax: Fax: US Tax ID # (for.

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How to fill out the CUSTOM SILICONE LINERS ORDER FORM - Otto Bock online

This guide provides detailed instructions on how to effectively complete the Custom Silicone Liners Order Form from Otto Bock. By following these steps, users can ensure that all necessary information is accurately provided to facilitate the order process.

Follow the steps to successfully complete the order form.

  1. Click ‘Get Form’ button to access the order form and open it for editing.
  2. Fill in the 'Bill To' section with the company name, address, city, state/province, phone, and fax numbers. This information should accurately reflect the billing details for the order.
  3. Complete the 'Ship To' section with all relevant details of the shipping address, including company name, address, city, state/province, and phone number.
  4. Enter the US Tax ID number for custom purposes, if applicable, along with the purchase order number and any existing Otto Bock account number.
  5. Provide the client's name or ID to identify the individual for whom the liners are being ordered. Include the contact person's details in this section.
  6. Specify the affected side by selecting either 'Left' or 'Right' to indicate which side requires the silicone liner.
  7. Input the date of the order. Ensure that the date is current and formatted correctly.
  8. Select the appropriate options for the liners from the provided options, including trial and final liners, ensuring that selections meet the needs of the user.
  9. For additional options on the final liner, specify any requests, such as measurement locations, thickness specifications, or attachment methods.
  10. Review the entire form for accuracy and completeness. After ensuring all fields are filled out correctly, users can save changes, download, print, or share the completed form as needed.

Complete your order form online today to ensure a smooth ordering process.

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The best price estimate that we have for the Empower Ankle is $40,000 to $50,000 US inclusive of all clinical fees.

Price. ing to our information, the C-Leg sells for between $40,000 and $50,000 US including the socket, prosthetic foot, and all prosthetist fees.

On Bionics for Everyone's table of prices for microprocessor knees (MPKs), the most affordable device listed is Ottobock's Kenovo at $25,000 to $35,000. Ottobock's C-Leg costs between $40K and $50K, and its highest-end device (the Genium X3) carries a six-figure price tag.

An above-knee prosthetic leg can cost anywhere from $5,000 to $70,000, depending on the brand, type of joint, and carbon foot selected. For example, the starting price of the Ottobock 3R80 Hydraulic System Above the Knee Prosthetic Leg is $8,500.

Price. ing to our information, the Genium X3 typically sells for more than $100,000 US including the socket, prosthetic foot, and all prosthetist fees.

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