FORM - G
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.
  • 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




*Qty


(A) Top Of Garment(in cms.)
(B) Waist On Navel (in cms.)
(C) Maximum Hip (in cms.)

(A) Gluteal Fold (cms.)
(B) Middle Of Thigh (cms.)
(1) A to B (cms.)
(2) B to D (cms.)
(3) D to E (cms.)
(4) A to C (cms.)






Left







Right

Desin Option :
Any Additional Information


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