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ChipFlow Custom Leg Order Form
Includes
Calf & Foot
- 1 Chipflow Calf
- 1 Compreboot Foot
- 1 Chip Foam Liner
- 1 Pair of non-compressive Basic Liners*Full Leg
- 1 Chipflow Full Leg
- 1 Compreboot Foot
- 1 Chip Foam Liner
- 1 Pair of non-compressive Cotton LinersIndications• Lymphedema • Edema
• LipedemaCare Instructions
- Machine wash on gentle cycle using a mild detergent
- DO NOT use bleach or fabric softeners
- Tumble dry on low heat setting. Air drying is recommended to preserve the life of the garment
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
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Medi Custom Arm Order Form
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
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Medi Custom Leg Order Form
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
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Medi Custom Toe Cap Order Form
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
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Jobst JoviPak Custom Leg Order Form
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
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Jobst JoviPak Custom Arm Order Form
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
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Jobst Relax Arm and Leg Order Form
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
Jobst Relax Order Form
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Jobst Relax Arm Order Form
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
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Jobst Confidence AG and AD order form
Custom garments are priced individually. Please call for more information you may also email or fax form over for pricing.
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TributeNight Pants with Foot Coverage – Custom
- Recommended for clients needing coverage from the toes to waist.
- Special modifications may need to be made depending on the client.
If ordering for a client over 250 lbs, please include current weight, mobility limitations and call to discuss options. - To order this custom product, please call us or click on the order form below. After having your physical therapist or medical provider fill out the form we will provide you pricing and place the order on your behalf.
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Solaris TributeNight Compression Pants
- Recommended for clients with normal flexibility and range of motion (Bilateral chaps are suggested for clients that require easier donning)
- Closely resembles running pants; Midline and lateral zippers are included on this garment, free of charge
- Please use two order forms for legs and indicate in the comments section zipper preference (proximal to distal or distal to proximal)
- To order this custom product, please call us or click on the order form below. After having your physical therapist or medical provider fill out the form we will provide you pricing and place the order on your behalf.
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TributeNight Thigh – Lower Quadrant Chap & Half Leg
- Appropriate for clients who have full involvement in one quadrant and partial involvement in the contralateral quadrant
- Please use two leg forms when ordering
To order this custom product, please call us or click on the order form below. After having your physical therapist or medical provider fill out the form we will provide you pricing and place the order on your behalf.
- Brands
- Upper Body
- Lower Body
- Head Neck and Torso
- Gender
- Accessories
- Custom Order Forms
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