Anatech Custom manufacturing

Anatech remains to be one of the leading Canadian distributors in our field. We are also one of the few companies still offering custom bracing.

Keeping true to our core values of quality, integrity and reliability, we vow to deliver innovative high quality products to "support active lifestyles".

It is our belief that providing excellent customer service is not based soley on what we deliver, but in our capacity to listen and act on what our customers need.

Custom Manufacturing

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 order date

Customer Tel:

Fax:

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date required

*Unless specified by customer, all orders are generally shipped by FedEx, although orders to the very remote areas are shipped by Canada Post. 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:

Patient’s name _________________________________

sleeves do not include straps. □knee sleeve* *Standard They will be added and charged upon request □knee support, stabilized □knee support, hinged □other _________________________

□3mm □5mm □beige □black □navy □Back panel w/mesh popliteal □Velcro closure top* □Lace-up closure top* *(cannot be done w/sup enclosed buttress)

Left (in./cm.)

Right (in./cm.)

________ above

________

________

________ above

________

________

________ above

________

________

KC

________

________

________ below

________

________

________ below

________

________

□AnaTex (black only) □royal □other __________ □Back panel w/AnaTex popliteal □Velcro closure bottom ** □Lace-up closure bottom** **(cannot be done w/inf enclosed buttress)

Buttress:

□removable □enclosed superior □split ‘U’ □Gel L-buttress □Firm L-buttress

□multi-function □enclosed inferior □Other __________ □Gel J-buttress □Firm J-buttress

Straps: *Default style - standard removable straps.

No indication below required

________ below

________

Brace length required. _________________

________

Office use only:

Straps: Top ______ Bottom ______

□helical straps □dynamic frontal straps (DNS) □superior – sewn on* □inferior – sewn on* □superior – premium reinforced * □inferior – premium reinforced*

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

Office use only:

SO#

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Knee Suppor ts AnaPr ene Custom Or der Options Velcro Closure Velcro closure may be added to either top or bottom of the brace for easier fitting. It should be noted that some compression is lost over a regular sleeve.

INDICATIONS ❖ Arthritic patients ❖ Elderly patients with weaker grip ❖ Slight edema around patella (May be tightened when it decreases) Please note - brace not guaranteed to fit if size of leg changes dramatically

Lace up front This option as the one above is useful when the patient has trouble in pulling on a regular sleeve, the laces can be adjusted to give a better and more even compression than the Velcro.

INDICATIONS ❖ Arthritic patients ❖ Elderly patients with weaker grip Please note - may also be ordered with full lace-up front with no hole

Mesh back panel This option relieves the bunching that can occur with many knee braces in the popliteal area. It should be noted that it does tend to lessen the pressure on the patella thus losing a little control.

Dynamic Frontal straps These straps surround the patella thus applying added pressure for greater control of patella tracking.

Helical straps These straps are useful where there is a degree of rotation in the knee.

Anatech Inc. 205 – 5920 #6 Road Richmond, B.C., Canada V6V 1Z1 Tel: (604) 273-2836 Fax: (604) 270-4512 Tel: 1-800-667-3442 Fax: 1-800-663-5290

Customer

order date

tel:

fax:

ordered by

PO# ship via* date required *Unless specified by customer, all orders are generally shipped by FedEx, although orders to the very remote areas are shipped by Canada Post. 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 ELBOW BRACES:

Patient’s name _________________________________

□Elbow sleeve

□3mm

□Elbow sleeve, hinged

□beige

□Elbow sleeve, hinged/hyperextension

□cubital cut-out

□cubital mesh panel

□other _________________________

□Velcro closure top

□Velcro closure bottom

□5mm □black

□AnaTex □navy

□royal

□other______

left

right

(in./cm.)

(in./cm.)

________ above

________

________

________ above

________

________

□removable donut buttress □removable tendon pad

EC

________

________

straps: *standard hinged elbows, sent without straps unless indicated.

________ below

________

________

________ below

________

________

buttress: *standard elbows, sent without buttresses unless indicated.

□superior strap □inferior strap □tendon strap for elbow sleeve

Brace length required _________________________ (Standard length manufactured, if not indicated. Sleeves: 9”. Hinged and hyperextension:12”) Special instructions / comments

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Anatech Inc. 205 – 5920 #6 Road Richmond, B.C., Canada V6V 1Z1 Tel: (604) 273-2836 Fax: (604) 270-4512 Tel: 1-800-667-3442 Fax: 1-800-663-5290

Customer

order date

tel:

fax:

ordered by

PO# ship via* date required *Unless specified by customer, all orders are shipped by CanPar, orders to the Maritime provinces are shipped by Canada Post. ETA for CanPar to the Western provinces: 2-5 business days; to Ontario and Quebec: 6-10 business days. ETA for Canada Post to the Maritime provinces by Expedited Post: 5-7 business days; by Express Post: 2-3 business days. 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 SHOULDER BRACES: Patient’s name: _________________________________

□Mesh Shoulder restraint (black only) □AnaPrene shoulder protector - standard □AnaPrene shoulder protector – rugby style

Gender:

□Mesh □beige □left

□3mm □black □right

(black, ryl & beige only)

A

________

________

Bicep Circ.

B

________

________

Chest Circ.

C

________

________

Waist Circ.

D

________

________

Axilla-Waist

E

________

________

□5mm □navy □bi-lateral

□royal

Style A: w/ Velcro hook up at both ends

783000 (1=left/ 2=right) SHOULDER RESTRAINT left(in./cm.) right(in./cm.)

Shldr-Elbw

M / F

□ Style B: w/ Velcro hook up at one end, hook down at other end.

□ *if nothing checked standard Style A will be applied*

** please see separate sheet for female version of shoulder restraint ** 744000 (1=left/ 2=right) SHOULDER PROTECTOR:

left(in./cm.)

right(in./cm.)

Bicep Circ.

B

________

________

Chest Circ.

C

________

________

Shldr – Shldr

S**

________

________

** only applicable for bilateral support (measure across back) Special instructions / comments SO#

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ANATECH A□ OWN LABEL B □ ship to account #:

Anatech Inc. 205 – 5920 #6 Road Richmond, B.C., Canada V6V 1Z1 Tel: (604) 273-2836 Fax: (604) 270-4512 Tel: 1-800-667-3442 Fax: 1-800-663-5290

Customer

order date

tel:

fax:

ordered by

PO# ship via* date required *Unless specified by customer, all orders are generally shipped by FedEx, although orders to the very remote areas are shipped by Canada Post.

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 SHOULDER BRACES: Gender:

Patient’s name: _________________________________

M / F

Patient’s height __________

□Mesh Shoulder restraint (black only)

□left

□right

□bi-lateral

783000 (1=left/ 2=right) SHOULDER RESTRAINT left(in./cm.) right(in./cm.)

C - Extra Measurements required for female:

Shldr-Elbw

A

________

________

1” below chest circumference

________

Bicep Circ.

B

________

________

over breast – chest circumference

________

Chest Circ. @ axilla

C

________

________

1” above chest circumference

________

Waist Circ.

D @ belly button

________

________

Additional helpful measurements (taken at back):

Axilla-Waist E Axilla to belly button

________

□

________

length from nape of neck to waist

________

width shoulder to shoulder

________

Dress shirt size (collar size) ** **very important for bilateral restraint

________

Style A: w/ Velcro hook up at both ends

□

Style B: w/ Velcro hook up at one end, hook down at other end.

*if nothing checked standard Style A will be applied*

Special instructions / comments

SO#

order entered by

shipped via

LOGO REQUEST

Required ship date

Actual ship date

weight

freight charge

ANATECH A□ OWN LABEL B □ ship to account #: