Durable Medical Equipment, Prosthetics Orthotics & 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Account Contact Information. Fill in the Name, Email, and Phone fields accurately to ensure proper communication.
3. Next, complete the Billing and Shipping section. Provide the PO#, select your Shipping Preference, and fill in both Billing and Shipping Addresses along with City, State, and Zip codes.
4. In the Patient Information section, enter the patient's Last Name and First Name. Specify their Gender, Weight, Height, and select the appropriate Leg option (Left or Right).
5. For Sizing details, choose from the provided size options based on your patient’s measurements. Ensure you check any custom fitting requirements if applicable.
6. Select any Accessories needed for the brace configuration. Make sure to note any special instructions that may be necessary for customization.

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