FORM - COMPRESSION STOCKING
Please Read & Follow the few Guidelines before Filling the measurement form 
 
  • Fill in all the measurements for both legs irrespective of your order.
  • Fill in all the measurements in CENTIMETERS.
  • Take all the measurements on bare skin (i.e. without the clothes).
  • For Length measurements keep the limbs straight.
  • If order is for both legs then minimum 2 pair order must be placed.
  • Please enter 10 Digit Patient Mobile No.
  • Please enter Landline No. with STD Code
* Are You a Diabetic Patient?    * Any Diabetic Patient in family?   
Date
*Patient's Name
*Patient's Age *Gender
*Mobile No.
Landline No.
STD Code No.
*Patient's Address

*Pincode
E-Mail
Doctor's Name
Doctor's Address

Pincode
*Indicated For
Other Indication
Doctor's Email


*Select the Design, Qty & Left-Right Indication


*Side


*Qty


(W) Waist Circumference(in cms.)

(A) Gluteal Fold (cms.)
(B) Middle Of Thigh (cms.)
(C) Just Above Knee (cms.)
(D) At Knee (cms.)
(E) Just Below Knee (cms.)
(F) Maximum Calf (cms.)
(G) Minimum Ankle (cms.)
(H) Cross On Heel (cms.)
(I) Middle Of Foot (cms.)
(J) Base Of Thumb (cms.)
(1) A to D (cms.)
(2) B to D (cms.)
(3) D to H (cms.)
(4) H to J (cms.)




Left















Right











Additional Attachements :
Any Additional Information


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