Tel: Fax:
Anatech Inc.
205 – 5920 #6 Road, Richmond, B.C. V6V 1Z1
Tel: (604) 273-2836 Fax: (604) 270-4512
Tel: 1-800-667-3442 Fax: 1-800-663-5290
Email to: orders@anatechinc.com
Email: ordered by
PO# ship via* date required
If your order needs to arrive by a certain date, please bring it to our attention for special handling and arranging for faster means of shipping.
billing address: shipping address:
CUSTOM BRACES:
knee sleeve*
*Standard sleeves do not include straps They will be added and charged upon request
knee support, stabilized
Patient’s name
3mm
5mm
beige □black □navy
royal □other __________ □knee support, hinged
Back panel w/mesh popliteal
Back panel w/AnaTex popliteal □other _________________________
Velcro closure top* □Velcro closure bottom **
Lace-up closure top* □Lace-up closure bottom ** *(cannot be done w/sup enclosed buttress) **(cannot be done w/inf enclosed buttress)
Left in cm Right in cm
Buttress: above
removable
multi-function above
enclosed superior
enclosed inferior above
split ‘U’
Firm L-buttress
Other __________
Firm J-buttress below
Straps: below
Brace length required.
Straps: Top ______ Bottom □ Default straps
dynamic frontal straps (DNS)* □inferior – sewn on*
Default style = standard removable straps *indcates alternate/added strapping feature w/surcharge □helical straps* □superior – sewn on* □superior – premium reinforced * □inferior – premium reinforced* Office use only:
Please provide adequate measurements for length of brace required – Measure knee centre, top and bottom circumference. Additional midway meas. between 2-3“ apart are also important (esp. on a larger patient or extended for a longer brace).
Special instructions / comments