Get Ok Limbs For Life Foundation Component Request Form 2018-2025

This guide provides comprehensive instructions for users on how to complete the OK Limbs For Life Foundation Component Request Form online. By following these steps, you can ensure that your submission is accurate and complete.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to acquire the form and open it for editing.
2. Fill in the date and clinic name at the top of the form.
3. Enter the prosthetist's name, along with their address, phone number, cell, email, and fax number.
4. Indicate whether the applicant is currently enrolled with Limbs for Life by selecting 'Yes' or 'No.'
5. Provide patient information, including the patient's name and weight. Check the appropriate types of amputation on the form.
6. For below knee (BK) or above knee (AK) amputations, enter required measurements and K-level, along with skin tone.
7. Select the preferred suspension type, ensuring to check if you are willing to accept brand substitutions.
8. In the components section, check all requested items and provide sizes as necessary, including foot type and impact level.
9. Specify details for any additional textiles, adapters, or hardware components needed.
10. Review all information entered to ensure accuracy, then save changes or download the completed form.
11. Once completed, you can choose to print or share the form via fax or email as indicated.

Complete your documents online today to ensure timely processing.