• 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.

    2021 Chipflow full leg order form

  • 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.

    Solaris TributeNight Leg & Torso Order Form

  • 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.

    Solaris TributeNight Leg & Torso Order Form

  • TributeNight Body Suit (Vertical Style)

    • Provides superior truncal coverage while remaining easy to don
    • V-neck, Round neck, Scoop neck, or Turtle neck options available; Scoop neck is default option unless otherwise noted on the order form
    • Detachable arms may be added for full upper body support

    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.

    Solaris TributeNight Torso Order Form

  • TributeNight Upper Torso & Neck

    • Provides circumferential coverage at the axilla level and addresses radiation fibrosis of the neck and clavicle
    • Refined style for improved comfort and fit
    • Zipper modification and Velcro®-closure modification come standard on this garment

    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.

    Solaris TributeNight Torso Order Form

  • TributeNight Bustier (Vertical Style)

    • Shoulderless design ideal for women with firm breasts who have had lumpectomies, breast reconstruction or augmentation
    • Extension of garment to the hips is recommended to cross the watershed at the waist
    • Zipper modification comes standard

    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.

    Solaris TributeNight Torso Order Form

  • TributeNight Thoracic Sling

    • Asymmetric wrap is left and right specific
    • Provides therapeutic benefits for unilateral chest wall swelling, radiation fibrosis and scarring
    • Please indicate the cup size of affected breast in the comments section on the order form

    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.

    Solaris TributeNight Torso Order Form

  • TributeNight Shorts – Chevron & Vertical Styles

    • Ideal for patients who require bandaging of the lower leg or need coverage of the buttocks and abdominals
    • Allows for bandaging over the thigh portion; patients also have the option of wearing bike shorts over the top
    • Zipper modification may be ordered for midline seam to ease donning and doffing
    • Available in Chevron or Vertical channels

    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.

    Solaris TributeNight Torso Order Form

  • TributeNight Abdominal Binder

    • Therapist designed to address swelling and tissue induration of the abdomen
    • Velcro®-receptive exterior fabric and hook and loop closures allow for girth fluctuations; comes in black fabric only
    • Darting can be incorporated for clients with rounded abdomens to provide full coverage and tissue support
    • Hook and loop closure comes standard

    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.

    Solaris TributeNight Torso Order Form

  • TributeNight Briefs (Vertical Channels)

    • Provides therapeutic coverage for the abdomen, genitals, and buttocks
    • Specifically designed with an extended waist to cross the transverse plane or watershed from the lower to upper quadrant and to complement manual therapeutic techniques
    • Combine with labia or scrotum Swell Spot (SP-15) for daytime use

    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.

    Solaris TributeNight Torso Order Form

  • TributeNight Orbital Unit

    • Orbital unit provides relief for swelling around the eyes and eye lids
    • Garment is able to be fitted with a thermoplastic mold
    • Standard hook and loop closure makes donning easy
    • Exterior fabric is Velcro®-receptive; available in black fabric only

    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.

    Solaris TributeNight Head & Neck Order Form

  • TributeNight Cervical Collar

    • This was created for clients who have thickened tissue due to radiation and/or post-surgical scarring; the collar is designed to fit contours of the neck
    • Standard hook and loop closure makes donning easy
    • Exterior fabric is Velcro®-receptive; available in black fabric only

    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.

    Solaris TributeNight Head & Neck Order Form

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