CircAid Forms - 12 pages

Transcription

2012 Order Forms & Sizing Guides
rev. 05
1
2012 Order Forms & Sizing Guides
Table of Contents
CircAid® General Order Form
2
Juxta-Lite™ Single Patient Order Form
3
Juxta-Lite™ Volume Stock Order Form
4
Juxta-Fit™ Premium & Essentials / Classic-Flex™ /
Ready-Fit™ Single Patient Order Form
5
Juxta-Fit™ Armsleeve Single Patient Order Form 6
Comfort Ancillaries™ Order Form
7
CircPlus™ Volume Stock Order Form
8
Juxta-CURES™ Volume Stock Order Form
9
Custom Garment Order Form and Instructions
10
Custom Legging Sizing Chart
11
Custom Armsleeve Sizing Chart
12
Package Contents
13
Terms and Conditions
14
2
order form
FACILITY NAME
DATE
CONTACT NAME
PHONE
FORM OF PAYMENT
FAX
Card Number:
EMAIL ADDRESS
Card Holder’s Name:
Expiration Date:
BILLING ADDRESS
ACCOUNT NUMBER2
PURCHASE ORDER NUMBER
SHIPPING METHOD3
SHIPPING ADDRESS (IF DIFFERENT FROM ABOVE)
ITEM NUMBER
1
2
3
ITEM DESCRIPTION
r
Ground
r
3 Day
r
2 Day
r
Next Day Saver
r
Next Day
(Early AM)
r
Next Day
(10:30AM)
SIZE
QUANTITY
Completed custom orders are processed within five business days.
For new accounts, an account setup form or credit application must be completed, the form is available for download at www.circaid.com. Credit process can take from 2-3 weeks to complete.
Shipping options vary by location.
CircAid Medical Products |
C-
OF-020612-01
3
SINGLE
PAT I E N T
or de r f or m
Email Order:
Facility Name
Contact Name
by 12:00PM PST 1
Form of payment
r COD r Purchase Order
date
FAX
PHONE
r American Express r VISA r MasterCard
Card Number:
EMAIL ADDRESS
Expiration Date:
Billing Address
Account Number2
Purchase Order Number
Patient name
facility reference
Shipping Address (if different from above)
Shipping method3
r Ground
r 3 Day
r 2 Day
r Next Day Saver
r Next Day (Early AM)
r Next Day (10:30AM)
sizing chart
Patient should be standing when taking measurements. Limbs should be at their smallest; limb size should be maintained from time of measurements to ensure a proper fit of the
garment. Be sure to select a length (D) and a legging size (B, C). Also, select a foot size (H) if ordering a detached Juxta-Lite™ Ankle-Foot Wrap (AFW). After measuring the smallest
dimension of the ankle and the largest dimension of the calf, if the measurements do not fall within one of these size ranges, call (800) 247-2243. Actual legging lengths are 28cm (Short)
and 33cm (Long). Note: Standard offering includes one legging, one BPS™ card, one Comfort Leg Liner™ and one pair of Comfort Compression Anklets™. The Comfort Leg Liner™ can be
upgraded to a Comfort Silver Leg Liner™ for an additional cost at the time of purchase. Note 1in = 2.54cm
MEASUREMENTS
left
right
B
C
H
D
left
LENGTH
right
SIZE
r LONG
r SHORT
LENGTH
SIZE
r LONG
r SHORT
qty:
foot options
SIZE
B
legging
C
SIZE
Small
medium
small
19-22cm
26-36cm
medium
22-27cm
33-44cm
MEDIUM
Full calf
22-27cm
44-54cm
large
25-32cm
41-51cm
large
Full calf
25-32cm
51-61cm
XL
30-37cm
37-48cm
xl
Full calf
30-37cm
48-61cm
XXL
35-42cm
53-64cm
H
LENGTH
MEASUREMENT
SIZE
D
19-26cm
SHORT
under
44cm
24-31cm
LONG
over
44cm
NOTE: The maximum limb circumference for the Juxta-Lite™
legging is 64cm. If your patient exceeds this measurement, a
custom Juxta-Fit™ legging is available for order.
The maximum foot arch circumference for the Juxta-Lite™ Ankle-Foot
Wrap is 31cm. The Comfort Compression Anklet™ maximum foot
arch circumference is 36cm for Standard and 41cm for Large, and the
maximum ankle circumference is 27cm for Standard and 50cm for
Large. If your patient exceeds these measurements, the Comfort EZ
Single-Band Ankle-Foot Wrap™ is available for order.
C
The maximum limb circumference for the:
• Comfort Knee-High Sock™ and Comfort Leg Liner™ is 64cm
• Comfort Knee-High Cotton-Terry Sock™ is 91cm
• Comfort Knee-High Silver Sock™ and Comfort Silver Leg Liner™ is 71cm
Additional ancillaries
qty:
COMFORT SILVER LEG LINER™
UPGRADE (ONE LINER)
AFW
MEASUREMENT
CIRCUMFERENCE MEASUREMENTS
Size
D
qty
comfort coverup™ for lower leg (black)
QTY:
(Small: 34cm - 50cm) (LARGE: 51cm - 80cm)
B
comfort coverup™ for lower leg (beige)
(Small: 34cm - 50cm) (LARGE: 51cm - 80cm)
QTY:
comfort cAPRI™
H
(for the sizing chart visit www.circaid.com)
JUXTA-LITE™ AFW SMALL
PAIR OF COMFORT COMPRESSION ANKLETS™
JUXTA-LITE™ AFW MEDIUM
PAIR OF Comfort LEG LINERS™ (footless)
N/A
COMFORT ez SINGLE-BAND AFW™
3"(7.6cm) WIDE
PAIR OF Comfort Silver LEG LINERS™ (FOOTLESS)
N/A
PAIR OF Comfort Knee-High Socks™
N/A
PAIR OF Comfort THIGH-High Socks™
N/A
PAIR OF Comfort Cotton Terry Knee-High Socks™
N/A
PAIR OF Comfort Cotton Terry THIGH-High Socks™
N/A
PAIR OF Comfort Silver Knee-High Socks™
N/A
PAIR OF Comfort Silver THIGH-High Socks™
N/A
INSTRUCTIONAL DVD
N/A
COMFORT ez SINGLE-BAND AFW™
4”(10.2cm ) WidE
1
Same day shipping to accounts in good standing for standard orders.
2
For new accounts, an account setup form or credit application must be
completed. The form is available for download at www.circaid.com.
3
Shipping options vary by locat
CircAid Medical Products | 9323 Chesapeake Drive, Suite B2, San Diego, CA 92123
Terms and Conditions: F.O.B., San Diego, CA. Net 30 for
approved accounts, all others C.O.D or credit card payment.
Visa, MasterCard, and American Express accepted. Please
request a Credit Application from Customer Service for
establishing an Account. Orders shipped outside of the
USA are payable in advance in U.S. dollars by draft on a U.S.
bank. CircAid Medical Products, Inc., assumes no liability
for injury or damages resulting from contraindicated use
of its products. CircAid is a Registered Trademark and
Comfort CoverUp, Juxta-Lite, Comfort Capri, Comfort Leg
Liner, Comfort Silver Leg Liner, Comfort Knee-High Sock,
Comfort Thigh-High Sock, Comfort Silver Knee-High Sock,
Comfort Silver Thigh-High Sock, Comfort Cotton Terry
Knee-High Sock, Comfort Cotton Terry Thigh-High Sock,
Comfort Compression Anklets, Comfort Knee-High
Stockinette, Comfort EZ Single-Band Ankle-Foot Wrap, and
BPS are trademarks of CircAid Medical Products, Inc.
©2012 CircAid Medical Products, Inc. All rights reserved.
PRICES SUBJECT TO CHANGE WITHOUT NOTICE.
JL-OF-052512-01
STOCK
Email Order:
by 12:00PM PST 1
order form
Choose the Perfect Alternative
Facility Name
V O L U ME
4
Contact Name
Form of payment
date
PHONE
FAX
Card Number:
EMAIL ADDRESS
Expiration Date:
Billing Address
Account Number2
Shipping method3
product selEction
(Write in the quantities of each product for the respective size)
SMALL
r Ground
r 3 Day
r 2 Day
r Next Day Saver
MEDIUM
MEDIUM
FULL CALF
LARGE
LARGE
FULL CALF
XL
FULL CALF
XL
XXL
JUXTA-LITE™ SHORT LEGGING WITH ANKLETS (28CM)
COMFORT SILVER LEG LINER™ UPGRADE (ONE LINER)
JUXTA-LITE™ LONG LEGGING WITH ANKLETS (33CM)
COMFORT SILVER LEG LINER™ UPGRADE (ONE LINER)
ADDITIONAL ANCILLARIES
(Write in the quantities of each product for the respective size)
ONE
SIZE
STANDARD
SMALL
MEDIUM
MEDIUM
FULL CALF
LARGE
LARGE
FULL CALF
XL
XL
FULL CALF
XXL
JUXTA-LITE™ INSTRUCTIONAL DVD
COMFORT COMPRESSION ANKLETS™ (PAIR)
(Buy 10 pairs and get 2 pairs free)
COMFORT EZ SINGLE-BAND ANKLE-FOOT WRAP™
3” wide (Discounted when ordered in pairs, see pricelist for more info)
COMFORT EZ SINGLE-BAND ANKLE-FOOT WRAP™
4” wide (Discounted when ordered in pairs, see pricelist for more info)
JUXTA-LITE™ ANKLE-FOOT WRAP
comfort coverup™ for lower leg (black)
comfort coverup™ for lower leg (beige)
Comfort LEG LINERS™ (footless PAIR)
Comfort Knee-High Socks™ (PAIR)
Comfort Cotton Terry Knee-High Socks™ (PAIR)
Comfort Silver Knee-High Socks™ (PAIR)
Comfort Silver Leg liners™ (PAIR)
COMFORT CAPRI™
SIZE A
SIZE B
SIZE C
SIZE D
SIZE E
SIZE F
SIZE G
SIZE H
SIZE I
SIZE J
F.O.B., San Diego, CA. Net 30 for approved accounts, all others C.O.D or credit card payment. Visa, MasterCard, and American Express accepted. Please request
a Credit Application from Customer Service for establishing an Account. Orders shipped outside of the USA are payable in advance in U.S. dollars by draft on a
U.S. bank. CircAid Medical Products, Inc., assumes no liability for injury or damages resulting from contraindicated use of its products. CircAid is a Registered
Trademark and Juxta-Lite, Comfort Compression Anklets, Comfort CoverUp, Comfort Capri, Comfort Leg Liner, Comfort Silver Leg Liner, Comfort Knee-High Sock,
Comfort Silver Knee-High Sock, Comfort Cotton Terry Knee-High Sock, Comfort EZ Single-Band Ankle-Foot Wrap are trademarks of CircAid Medical Products, Inc.
©2012 CircAid Medical Products, Inc. All rights reserved. PRICES SUBJECT TO CHANGE WITHOUT NOTICE.
1
2
3
For new accounts, an account setup form or credit application must be completed. The form is available for download at www.circaid.com.
CircAid Medical Products, INC. | 9323 Chesapeake Drive, Suite B2, San Diego, CA 92123 |
JL-BO
-050212-02
CLASSIC-FLEX™
ready-fit™
5
PREMIUM & ESSENTIALS
SINGLE
or de r f or m
E
Facility Name
PAT I E N T
mail Order:
Contact Name
by 12:00PM PST 1
Form of payment
date
PHONE
FAX
Card Number:
EMAIL ADDRESS
Expiration Date:
Billing Address
Account Number2
Patient name
facility reference
Shipping method3
r Ground
r 3 Day
r 2 Day
r Next Day Saver
sizing chart
Patient should be standing when taking measurements. Limbs should be at their smallest; limb size should be maintained from time of measurements to ensure a proper fit of
garment. When on borderline between sizes, select a smaller size if significant edema is present and reduction is anticipated; if edema is minimal, select larger size. After
measuring the smallest dimension of the ankle and the largest dimension of the calf, if any of the measurements do not fall within one of these size ranges, call (800) 247-2243.
Length measurement is for Juxta-Fit™ only, actual legging lengths are 28cm (Short) and 36cm (Long); Ready-Fit™ and Classic-Flex™ have one adjustable length. Note 1in = 2.54cm
MEASUREMENTS
left
classic-flex™ & ready-fit™
right
B
B1
C
B
B1
C
SIZE
B
B1
C
SIZE
H
Small
19-24cm
small
15-23cm
20-28cm
30-38cm
small
15-23cm
20-28cm
30-38cm
medium
24-29cm
large
29-34cm
medium
20-28cm
25-33cm
36-43cm
medium
20-28cm
25-33cm
large
25-33cm
30-38cm 41-48cm
MEDIUM
Full calf
20-28cm
33-40cm 43-50cm
XL
30-38cm
36-46cm 46-56cm
large
25-33cm
30-38cm 41-48cm
33-41cm
43-53cm
large
Full calf
25-33cm
38-46cm 48-56cm
XL
30-38cm
33-41cm 41-51cm
xl
Full calf
30-38cm
41-51cm
51-61cm
XXL*
33-41cm
43-53cm
53-64cm
XXL
53-64cm
* If measurements fall within XXL size range, please
consider ordering a custom Juxta-Fit™ for optimal fit.
‡
EZ Single-Band Ankle-Foot Wrap™ included by default
§
Juxta-Lite™ Ankle-Foot Wrap is available only in sizes
Small and Medium
†
Comfort Compression Anklets™ included by default
Legging options
size:
QTY:
28cm Juxta-Fit™ Premium †
Standard Lower Legging (short)
circumference measurement
SIZE
H
B-D
AFW
MEASUREMENT
Juxta-Fit™ Premium & Essentials
circumference measurement
36cm Juxta-Fit™ Premium
Standard Lower Legging (long)
36-43cm
LENGTH
MEASUREMENT
B-D
SIZE
under
36cm
over
36cm
SHORT
LONG
†
foot options
28cm Juxta-Fit™ essentials †
Standard Lower Legging (short)
Ready-Fit™ Standard Lower
Legging ‡
Classic-Flex™ Standard Lower
Legging ‡
comfort coverup™ for lower
leg (black) (Small: 34cm - 50cm)
leg (black) (Large: 51cm - 80cm)
leg (beige) (Small: 34cm - 50cm)
leg (beige) (Large: 51cm - 80cm)
comfort cAPRI™
(For a sizing chart visit www.circaid.com)
INSTRUCTIONAL DVD
qty:
Comfort Compression Anklets™ (Standard max circumference
H = 36cm B = 27cm) (Large max circumference H = 41cm B = 50cm)
36cm Juxta-Fit™ essentials †
Standard Lower Legging (long)
ancillaries
size:
25 cm above
malleolus
Comfort EZ Single-Band Ankle-Foot Wrap™ (3”)
N/A
N/A
Standard Juxta-Fit™ Ankle-Foot Wrap (max H circumference 34cm)
size:
QTY:
15 cm above
malleolus
C
B1
Standard Juxta-Fit™ Interlocking Ankle-Foot Wrap (max H circ. 34cm)
B-D
Custom Juxta-Fit™ Interlocking Ankle-Foot Wrap
Juxta-Lite™ Ankle-Foot Wrap (max H circumference 31cm) §
F.O.B., San Diego, CA. Net 30 for approved accounts, all others C.O.D or credit card payment.
Visa, MasterCard, and American Express accepted. Please request a Credit Application from
Customer Service for establishing an Account. Orders shipped outside of the USA are payable
in advance in U.S. dollars by draft on a U.S. bank. CircAid Medical Products, Inc., assumes no
liability for injury or damages resulting from contraindicated use of its products. CircAid is a
Registered Trademark, Juxta-Fit, Juxta-Lite, Classic-Flex and Ready-Fit are trademarks of CircAid
Medical Products, Inc. ©2012 CircAid Medical Products, Inc. All rights reserved.
5 cm above
malleolus
B
H
1
2
3
JF-OF-050212-02
6
SINGLE
armsleeve
Facility Name
PAT I E N T
or de r f or m
Fax Order:
Email Order:
Contact Name
by 12:00PM PST 1
Form of payment
date
PHONE
FAX
Card Number:
EMAIL ADDRESS
Expiration Date:
Billing Address
Account Number2
Patient name
facility reference
Shipping method3
r Ground
r 3 Day
r 2 Day
r Next Day Saver
The Juxta-Fit™ Armsleeve is constructed from the wrist to the axilla measurement. A lateral rise is incorporated at the top of the
garment in addition to a 10° bend is at the elbow. Measure patient’s arm length with the arm bent at 35°. Also ensure that the arm
is at its smallest and maintain arm size at time of measuring to assure a proper fit of the garment(s). NOTE: 1in = 2.54cm
CoverUp color
ARM AND hand
Juxta-Fit™ gauntlet size OPTIONS
selection
r BLACK
r RIGHT
r LEFT
ARM LENGTH
c-e
c-g
r BEIGE
r PINK
PALM
circumference
14-17cm
17-20cm
20-23cm
23-26cm
26-29cm
SIZE
r XSMALL
r SMALL
r MEDIUM
r LARGE
r XL
HAND OPTIONs
Juxta-Fit™ GLOVE measurements
r GAUNTLET
r GLOVE
wrist to
elbow crease
wrist to axilla
(or where the
garment should
end)
(Palm; Wrist; 5cm increments
from the wrist to the axilla)
2
3
4
5
6
7
8
1x
2x
3x
4x
5x
a
b
c
1w
2w
3w
4w
5w
Length
r DORSUM
STRAP
circumference
Wrist
5cm
10cm
15cm
20cm
25cm
30cm
c-g
10
3
2
Points
Palm
9
c-e
r NONE
ARM Circumference
Measuring
Measurements
1
Measurements 1w-5w:
the circumference where
the glove should end;
commonly, the Distal
Interphalangeal joint (DIP).
Measurements 1x-5x:
the circumference of each
finger at the Proximal
Interphalangeal joint
(PIP) or if the base of the
finger is larger than the
PIP please use the larger
measurement.
3w
4w
2w
1
3x
4x
2x
1x
35cm
Measurement a:
circumference of
palm at base of
pinky finger
40cm
Measurement b:
circumference of palm at
base of thumb webbing
45cm
Measurement c:
circumference of the wrist
5
6
10
5w
9
5x
a
1w
Measurements 1-5: length
of finger from the center of the
crease at base to where the
glove should end
Measurement 6: length from
base of index finger to the base of
thumb webbing
4
b
base of index finger (same as 6)
to base of palm
7
8
the crease between the ring finger
and pinky finger to the base of
the palm
Measurement 9: width of palm
at base of thumb webbing
Measurement 10: width of palm at base of pinky finger
c
50cm
55cm
1 Completed custom orders are processed within five business days.
2 For new accounts, an account setup form or credit application must be completed.
The form is available for download at www.circaid.com. Credit process can take from 2-3 weeks to complete.
3 Shipping options vary by location.
Terms and Conditions: F.O.B., San Diego, CA. Net 30 for approved accounts, all others C.O.D
or credit card payment. Visa, MasterCard, and American Express accepted. Please request a
Credit Application from Customer Service for establishing an Account. Orders shipped outside
of the USA are payable in advance in U.S. dollars by draft on a U.S. bank. CircAid Medical
Products, Inc., assumes no liability for injury or damages resulting from contraindicated use of
its products. CircAid is a Registered Trademark and Juxta-Fit is a trademark of CircAid Medical
Products, Inc. ©2011 CircAid Medical Products, Inc. All rights reserved.
JFA-
OF-020712-01
7
or de r f or m
ancillaries
Facility Name
Email Order:
Contact Name
by 12:00PM PST 1
Form of payment
date
PHONE
FAX
Card Number:
EMAIL ADDRESS
Expiration Date:
Billing Address
Account Number2
Shipping method3
ancillaries
Size
r Ground
r 3 Day
r 2 Day
r Next Day Saver
quantity
Comfort CoverUp™ sIZING
COMFORT COMPRESSION Anklets™ †
Standard: max arch circumference 36cm; max ankle circumference 27cm
large: max arch circumference 41cm; max ankle circumference 50cm
Armsleeve Comfort CoverUp™ (Beige)
SMALL
LARGE
Comfort CoverUp™ Below Knee
34cm -50cm
51cm -80cm
Comfort CoverUp™ Whole Leg
50cm - 71cm 72cm - 108cm
Armsleeve Comfort CoverUp™ (Black)
Comfort CoverUp™ Arm
26cm - 39cm
Armsleeve Comfort CoverUp™ (Pink)
Note: Take measurements while wearing your compression garment to
ensure the best fit. A custom Comfort CoverUp™ is available for those who
do not fit in the above size ranges.
Lower Leg Comfort CoverUp™ (Beige)
40cm - 60cm
Lower Leg Comfort CoverUp™ (Black)
CAPRI SIZING
Whole Leg Comfort CoverUp™ (Beige)
Whole Leg Comfort CoverUp™ (Black)
ancillaries
T
ONE-SIZE
comfort Non-Slip Liner™ 18”x30”*
comfort Non-Slip Liner™ 18”x60”
*
‡
COMFORT EZ Single-Band Ankle-Foot Wrap™ (3” wide)
G
Size
Waist (T)
Thigh (G)
circumference
LARGEST
Circumference
A
63cm - 79cm
46cm - 62cm
B
67cm - 85cm
49cm - 65cm
C
72cm - 91cm
52cm - 70cm
D
76cm - 96cm
55cm - 73cm
E
81cm - 102cm
60cm - 81cm
F
85cm - 108cm
63cm - 84cm
Comfort Arm Liner™ (With thumbhole) maximum limb circumference: 54cm
G
90cm - 113cm
67cm - 90cm
Comfort leg Liner™ (Footless) maximum limb circumference: 64cm†
H
94cm - 119cm
70cm - 93cm
COMFORT EZ Single-Band Ankle-Foot Wrap™ (4” wide)‡
Comfort Cotton Terry Knee-High Socks™ maximum limb circumference: 91cm
†
Comfort Cotton Terry Thigh-High Socks™ maximum limb circumference: 91cm†
Comfort Knee-High Socks™ maximum limb circumference: 64cm†
Comfort Thigh-High Socks™ maximum limb circumference: 79cm
†
I
99cm - 125cm
72cm - 96cm
J
103cm - 130cm
77cm - 102cm
When taking measurements, measure at the
largest circumference point. When selecting a
size, choose the smallest size match for the most
snug fit. Choose the largest size match for a more
relaxed, easy to wear to fit.
Comfort SilVer Arm Liner™ (With thumbhole) maximum limb circumference: 54cm
Comfort SILVER leg Liner™ (Footless) maximum limb circumference: 71cm†
Comfort Silver Knee-High Socks™ maximum limb circumference: 71cm†
DISCOUNTS:
Buy 4 or more Comfort Non-Slip Liners™ and get 50% off.
†
Buy 10 pairs and get 2 free.
‡
Discounted when ordered in pairs, see your pricelist for more information.
Comfort Silver Thigh-High Socks™ maximum limb circumference: 71cm†
*
Comfort arm Stockinette™ (SINGLE PLY) maximum limb circumference: 56cm†
Comfort Thigh-High Stockinette™ (SINGLE PLY) maximum limb circumference: 100cm†
Comfort Knee-High Stockinette™ (DOUBLE PLY) maximum limb circumference: 66cm†
Comfort Thigh-High Stockinette™ (DOUBLE PLY) maximum limb circumference: 100cm†
comfort capri™
size a
size B
size C
size D
size E
size F
size G
size H
size I
size J
Terms and Conditions: F.O.B., San Diego, CA. Net 30 for approved accounts, all others C.O.D or credit card payment. Visa, MasterCard, and American Express accepted. Please request a Credit Application from Customer
Service for establishing an Account. Orders shipped outside of the USA are payable in advance in U.S. dollars by draft on a U.S. bank. CircAid Medical Products, Inc., assumes no liability for injury or damages resulting from
contraindicated use of its products. CircAid is a Registered Trademark and Comfort Capri, Comfort Non-Slip Liner, Comfort CoverUp, Comfort Cotton Terry Knee-High Sock, Comfort Cotton Terry Thigh-High Sock, Comfort
Arm Liner, Comfort Leg Liner, Comfort Knee-High Sock, Comfort Thigh-High Sock, Comfort Silver Arm Liner, Comfort Silver Knee-High Sock, Comfort Silver Thigh-High Sock, Comfort Arm Stockinette, Comfort Thigh-High
Stockinette and Comfort Knee-High Stockinette are trademarks of CircAid Medical Products, Inc. ©2012 CircAid Medical Products, Inc. All rights reserved.
3
1
2
C-
OF-050212-02
V O L U ME
VEIN PROCEDURE COMPRESSION SYSTEM
Facility Name
STOCK
or de r f or m
Fax Order:
Email Order:
Contact Name
by 12:00PM PST 1
Form of payment
date
PHONE
FAX
Card Number:
EMAIL ADDRESS
Expiration Date:
Billing Address
Account Number2
Shipping method3
r Ground
r 3 Day
r 2 Day
r Next Day Saver
Patient should be standing when taking measurements. Limbs should be at their smallest; limb size should be maintained from time of
measurements to assure a proper fit of garment. When measurements fall into multiple sizes, choose the capri size where the waist
measurement is in the middle of the range. After measuring the smallest dimension of the ankle and the smallest dimension of the waist,
if any of the measurements do not fall within one of these size ranges, call Customer Service at (800) CIRCAID (247-2243).
waist circumference at
the smallest dimension
T
H
ANKLE circumference at
the smallest dimension
QUANTITY
Inches
Waist
ANKLE
(T)
(h)
Centimeters
Waist
ANKLE
(t)
(h)
A
25 - 31
7-8
63 - 79
18 - 20
B
26 - 33
7-8
67 - 85
18 - 20
C
28 - 36
8 - 9.5
72 - 91
21 - 24
D
30 - 38
8 - 9.5
76 - 96
21 - 24
E
32 - 40
8 - 9.5
81 - 102
21 - 24
F
33 - 43
9.5 - 11
85 - 108
25 - 28
G
35 - 44
9.5 - 11
90 - 113
25 - 28
H
37 - 47
9.5 - 11
94 - 119
25 - 28
I
39 - 49
9.5 - 11
99 - 125
25 - 28
J
41 - 51
9.5 - 11
103 - 130
25 - 28
Size
Terms and Conditions: F.O.B., San Diego, CA. Net 30 for approved accounts, all others C.O.D or credit card payment. Visa, MasterCard, and American Express accepted. Please request a
Credit Application from Customer Service for establishing an Account. Orders shipped outside of the USA are payable in advance in U.S. dollars by draft on a U.S. bank. CircAid Medical
Products, Inc., assumes no liability for injury or damages resulting from contraindicated use of its products. CircAid is a Registered Trademark and CircPlus is a trademark of CircAid
Medical Products, Inc. ©2011 CircAid Medical Products, Inc. All rights reserved.
1
2
3
For new accounts, an account setup form or credit application must be completed, the form is available for download at www.circaid.com.
CircAid Medical Products | 9323 Chesapeake Drive, Suite B2, San Diego, CA 92123 |
CP-VSOF-110111-01
8
V O L U ME
9
STOCK
order form
Fax Order:
Facility Name
Email Order:
Contact Name
by 12:00PM PST 1
Form of payment
date
PHONE
FAX
Card Number:
EMAIL ADDRESS
Expiration Date:
Billing Address
Account Number2
Shipping method3
r Ground
r 3 Day
r 2 Day
r Next Day Saver
product selEction
QTY
Juxta-CURES™ (Short 28cm) - 5 Pack of Short Leggings
Juxta-CURES™ (Standard 33cm) - 5 Pack of Standard Leggings
Juxta-CURES™ (Long 38cm) - 5 Pack of Long Leggings
Juxta-CURES™ (Trial) - 4 Pack of 2 Short Leggings and 2 Standard Leggings
ADDITIONAL ANCILLARIES
QTY
Comfort EZ Single-Band Ankle-Foot Wrap™ 3” Wide (Discounted when ordered in pairs, see pricelist for more info)
Comfort EZ Single-Band Ankle-Foot Wrap™ 4” Wide (Discounted when ordered in pairs, see pricelist for more info)
Comfort Compression Anklets™ (Standard Pair) - Buy 10 pairs and get 2 pairs free!
maximum arch circumference 36cm; maximum ankle circumference 27cm
Comfort Compression Anklets™ (Large Pair) - Buy 10 pairs and get 2 pairs free!
maximum arch circumference 41cm; maximum ankle circumference 50cm
Comfort Leg Liners™ (Footless Pair) - Buy 10 pairs and get 2 pairs free!
Comfort Silver Leg Liners™ (Footless Pair) - Buy 10 pairs and get 2 pairs free!
Comfort Knee-High Socks™ (Pair) - Buy 10 pairs and get 2 pairs free!
Comfort Cotton Terry Knee-High Socks™ (Pair) - Buy 10 pairs and get 2 pairs free!
Comfort Silver Knee-High Socks™ (Pair) - Buy 10 pairs and get 2 pairs free!
F.O.B., San Diego, CA. Net 30 for approved accounts, all others C.O.D or credit card payment. Visa, MasterCard, and American Express accepted. Please request a
Credit Application from Customer Service for establishing an Account. Orders shipped outside of the USA are payable in advance in U.S. dollars by draft on a U.S.
bank. CircAid Medical Products, Inc., assumes no liability for injury or damages resulting from contraindicated use of its products. CircAid is a registered trademark.
Juxta-CURES, Compression Ulcer Recovery System, Comfort Compression Anklet, Comfort Leg Liner, Comfort Silver Leg Liner, Comfort Knee-High Sock, Comfort
Silver Knee-High Sock, Comfort Cotton Terry Knee-High Sock, and Comfort EZ Single-Band Ankle-Foot Wrap are trademarks of CircAid Medical Products, Inc.
©2012 CircAid Medical Products, Inc. All rights reserved.
1
2
3
CircAid Medical Products, INC. | 9323 Chesapeake Drive, Suite B2, San Diego, CA 92123
JC-BO
-050212-02
10
C U S T OM ga r m e nt
ORDER FORM
Facility Name
Contact Name
Form of payment
date
PHONE
FAX
Card Number:
EMAIL ADDRESS
Expiration Date:
Billing Address
Account Number2
Patient name
facility reference
Item Number
Shipping method3
r Ground
r 3 Day
r Next Day Saver
r Next Day (Early AM) r Next Day (10:30AM)
Item Description
r 2 Day
Size
Quantity
Instructions for custom orders
1.
Patient: a) should be measured when limb is at its smallest; b) should be in standing position, if possible; c) limb size should be maintained at time of
measuring to assure a proper fit.
2.
Patient can reach ankles, or will have assistance in applying the garment and adjusting the straps throughout the day.
r Yes
r No (If no, patient is not a good candidate for the garment).
3.
Include the corresponding custom armsleeve or custom legging sizing chart(s) with your order form (page 11 or 12).
4.
Facility and patient acknowledge that custom-made products are warranted to be free of defects in materials and workmanship and can be returned for
alterations and repairs only (alteration fee, based on garment and alteration requested, will apply).
r Yes
r No
5.
ACKNOWLEDGEMENT: For Whole Legging, Upper Legging, Upper Legging w/Knee, Knee Piece and Lower Legging w/Knee, if the garment is not used as
directed, it may slip during daytime use.
r N/A
r Yes
6.
Prior to finalizing Graduate orders, please send the following sample:
r No: Patient is familiar with the garment or this is a reorder
r N/A
7.
r Yes: Please send a Graduate sample
Patient has uncommon shape, skin folds, tissue mass/shelves, or any other conditions out of the ordinary as described in detail below (provide circumference
measurements of leg above and below shelf, size of mass, location on limb, etc).
r Posterior, anterior, medial, and lateral pictures of limb, including foot forthcoming (DO NOT FAX. Send images via email to [email protected] and
specify in the subject line: Pics / facility name & patient’s first name and last initial; or send via USPS Mail).
r N/A
8.
1
2
3
A thick, cotton terry sock is available at no additional cost if the patient’s skin is compromised and additional cushioning is needed. Be sure to request this
sock when you send in your order by product #RSOCT001 (knee-high) or #RSOCT002 (thigh-high).
Completed custom orders are processed within five business days.
For new accounts, an account setup form or credit application must be completed. The form is available for download at www.circaid.com. Credit process can take 2-3 weeks to complete.
Shipping options vary by locat
CircAid Medical Products | 9323 Chesapeake Drive, Suite B2, San Diego, CA 92123 |
C
A-OF-091211-01
11
C U S T OM l e gging
SI Z I NG C HA RT
date
patient name
facility name
contact
reorder
r Yes
Circumference
Measurements
Left
r No
Landmark
Measuring
Points
1. This chart must be submitted with a completed Custom Garment Order Form on page 10.
E
circumference at
center of patella*
3. Complete length and foot measurements. Provide contour and linear lengths when measuring an uncommon limb shape.
Right
2. Record all measurements in centimeters. Take circumference measurements starting at the malleolus and every 5cm above.
For Lower Leggings end circumference measurements at knee crease. All other garments continue taking circumference
measurements up the leg, including the patella, to the groin (required for proper knee-and-above positioning and
placement).
4. Take measurements in shaded areas for standard sized leggings and ankle-foot wraps. NOTE: 1in = 2.54cm
Juxta-Fit™ standard legging sizes
B ankle
circumference
around malleoli
Small
Medium
Medium Full Calf
Large
Large Full Calf
XL
XL Full Calf
XXL
5cm
15-23cm
20-28cm
20-28cm
25-33cm
25-33cm
30-38cm
30-38cm
33-41cm
20-28cm
25-33cm
33-40cm
30-38cm
38-46cm
33-41cm
41-51cm
43-53cm
30-38cm
36-43cm
43-50cm
41-48cm
48-56cm
41-51cm
51-61cm
53-64cm
10cm
15cm
20cm
25cm
30cm
PRODUCT SELECTION
35cm
28cm Juxta-Fit™ Premium Standard Lower Legging (Short)§
60cm
r
r
r
r
r
r
r
65cm
r
Juxta-Fit™ Custom Lower Legging w/Knee‡
70cm
r
Juxta-Fit™ Custom Upper Legging w/Knee
r
Juxta-Fit™ Whole Legging (please choose CoverUp color below)
r
Classic Flex™ Custom Lower Legging
r
Graduate™ Whole Leg (please choose CoverUp color below)
r BLACK
r BEIGE
r
Graduate™ BK
r
Graduate™ Boot Only
40cm
45cm
50cm
55cm
B-K
75cm
E*
*
B-G
80cm
*
B-E*
Left
B-D
Right
B-D medial length
from prominent point of
malleolus to knee crease
foot
Measurements
left
Juxta-Fit™ Custom Lower Legging (only)‡
Juxta-Fit™ Custom Knee Piece (only)
Juxta-Fit™ Custom Upper Legging (only)
r
BLACK
BEIGE
GRADUATE™ COLOR OPTIONS
>36cm Long
Exterior
Foam Liner
Interior
Foam Liner
from prominent point
of malleolus to center of
patella*
B-K lateral length
malleolus to gluteal fold*
36cm Juxta-Fit™ Essentials Standard Lower Legging (Long) §
<36cm Short
B-E lateral length
B-G medial length
malleolus to groin, far
enough below pubic area
so that garment will not
cause discomfort*
28cm Juxta-Fit™ Essentials Standard Lower Legging (Short) §
r
85cm
length MeasurementS
36cm Juxta-Fit™ Premium Standard Lower Legging (Long) §
r
BLACK
N/A
r
BEIGE
r
RED
r
BEIGE
r
RED
SELECT Foot OPTION
MEASUREMENT STARTS FROM MALLEOLUS, NOT FROM FLOOR
Note: Measurements B-D & B-G are where garment will typically begin
and end. If Shelves, Folds, or Trouble Areas are Present, Please Draw
Shape of Patient’s Leg Darker on Sample or on Separate Sheet.
*Required for ALL except Lower Legging
Landmark
Measuring Points
right
B ankle circumference around malleoli
H arch circumference
jUXTA-FIT™ & JUXTA-LITE™
standard ankle foot wrap
(AFW) sizes
S
M
L
< 36cm
< 36cm
< 41cm
19-24cm
24-29cm
29-34cm
> 9cm
> 9cm
> 9cm
‡
Z length from base of toes to back of heel (For Interlocking AFW)
13-25cm
13-25cm
13-25cm
§
Z length for Standard Juxta-Fit™ & Juxta-Lite™ AFW§
> 16cm
> 16cm
> 16cm
A-Y length from base of great toe to where foot meets ankle
B-Z length from floor to center of medial malleoli
A circumference at base of toes
Y circumference around heel to where foot meets ankle
P2 length from malleoli to malleoli, pass under heel
r
TURQUOISE
r
TURQUOISE
‡
r
Comfort Compression Anklet™ Standard
(max H circumference 36cm; max B circumference 27cm)
r
Comfort Compression Anklet™ Large
(max H circumference 41cm; max B circumference 50cm)
r
r
r
Standard Juxta-Fit™ Ankle-Foot Wrap (max H circumference 34cm)
r
Standard Juxta-Fit™ Interlocking Ankle-Foot Wrap (max H circ. 34cm)
r
Custom Juxta-Fit™ Ankle-Foot Wrap
r
Juxta-Lite™ Ankle-Foot Wrap (max H circumference 31cm)
r
ATTACHED
r
SEPARATE
EZ Single-Band Standard Ankle-Foot Wrap™ included by default
Comfort Compression Anklets™ included by default
Juxta-Lite™ AFW not available in large
§
A-Y
P32
Y
A
B
B-Z
H
Z
CA-CSL-050212-02
12
C U S T OM A RM S L EE V E
date
SI Z I NG C HA RT
patient name
facility name
contact
reorder
r Yes
ARMSLEEVE pRoduct
r Juxta-Fit™ Armsleeve
r No
r Measure-Up™ Armsleeve
This chart must be submitted with a completed Custom Garment Order Form from page 10. Measure patient’s arm length with the arm straight. Also, ensure
that the arm is at its smallest and maintains arm size from the time of measuring to assure a proper fit of the garment(s). 1in = 2.54cm
Note: Juxta-Fit™ Armsleeve length (measured medially) is determined from wrist-to-axilla length provided. A lateral rise is incorporated at the top of the
garment in addition to a 10° bend at the elbow. Each Juxta-Fit™ Armsleeve comes with a Comfort CoverUp™ (a beige coverup will be sent if a color is not
selected.)
Note: Measure-Up™ Armsleeve length (measured medially) is determined from wrist-to-axilla length provided. If this length is equal to the borderline, the
armsleeve is built to the longer length unless specifically requested to be built to the shorter length (see measurement chart below). Each Measure-Up™
Armsleeve comes with a hand cover and a Comfort CoverUp™ (a black CoverUp will be sent if a color is not selected.)
Juxta-Fit™
HAND OPTIONs
r GAUNTLET
r DORSUM STRAP
r NONE
c-e
ARM AND hand
selection
r RIGHT
r LEFT
ARM LENGTH
c-e
wrist to
elbow crease
GARMENT
LENGTH
r 37cm (6 bands) r 43cm (7 bands) r 49cm (8 bands) r 56cm (9 bands)
c-g Measurement
Ranges
r GLOVE
c-g
mEASURE-UP™ OPTIONS
33cm -39.4cm
39.4cm-45.8cm
45.8cm -52.1cm
52.1cm -58.5cm
r BLACK
r BEIGE
r RED
r TURQUOISE
n/a
r BEIGE
r RED
r TURQUOISE
EXTERIOR
FOAM LINER
INTERIOR
FOAM LINER
Comfort CoverUp™
Comfort ancillaries™ undersleeve options
r BLACK
r Comfort Arm Liner™ (With thumbhole) max limb circumference: 54cm
r BEIGE
r Comfort SilVer Arm Liner™ (With thumbhole) max limb circ: 54cm
r PINK
r Comfort arm Stockinette™ (SINGLE PLY) max limb circumference: 56cm
Juxta-Fit™ gauntlet size OPTIONS
c-g
PALM circumference
14-17cm
17-20cm
20-23cm
23-26cm
26-29cm
SIZE
r XSMALL
r SMALL
r MEDIUM
r LARGE
r XL
wrist to axilla (or
where the garment
should end)
ARM Circumference
Measuring
Measurements
(Palm; Wrist; 5cm increments
Points
Juxta-Fit™ GLOVE measurements
Length
1
2
3
4
5
6
7
8
1x
2x
3x
4x
5x
a
b
c
1w
2w
3w
4w
5w
9
10
from the wrist to the axilla)
Palm
Wrist
circumference
5cm
3
2
4
10cm
15cm
20cm
25cm
30cm
35cm
40cm
45cm
5
Measurement a:
circumference of
palm at base of
pinky finger
Measurement b:
circumference of
palm at base of
thumb webbing
Measurement c:
circumference of
the wrist
3w
4w
2w
1
3x
4x
2x
1x
50cm
b
5w
9
Measurements 1-5: length
of finger from the center of the
crease at base to where the
glove should end
base of index finger to the base of
thumb webbing
7
8
Measurement 7: length from base
of index finger (same as 6) to base
of palm
55cm
Measurements 1x-5x: the circumference of each finger at the
Proximal Interphalangeal joint (PIP) or if the base of the finger is
larger than the PIP please use the larger measurement.
Measurements 1w-5w: the circumference where the glove
should end; commonly, the Distal Interphalangeal joint (DIP).
10
5x
a
1w
6
Measurement 8: length from the crease between the ring finger
and pinky finger to the base of the palm
Measurement 9: width of palm at base of thumb webbing
c
Measurement 10: width of palm at base of pinky finger
CA-CSA-020712-01
13
PACKAGE CONTENTS
Standard size compression systems:
•
Juxta-Fit™ premium Standard Leggings: one compression legging, one pair of Comfort Silver Leg Liners™, and one
pair of Comfort Compression Anklets™. (Comfort EZ Single-Band Ankle-Foot Wrap™ available upon request.)
•
Juxta-Fit™ Essentials Standard Leggings: one compression legging, one pair of Comfort Leg Liners™, and one pair of
Comfort Compression Anklets™. (Comfort EZ Single-Band Ankle-Foot Wrap™ available upon request.)
•
Juxta-lite™ standard Leggings: one compression legging, one Comfort Leg Liner™, BPS™ card and a pair of Comfort
Compression Anklets™.
•
Interlocking Standard Leggings (rEADY-FIT™ AND CLASSIC-FLEX™): one compression legging, one pair of Comfort
Knee-High Socks™, a Comfort EZ Single-Band Ankle-Foot Wrap™ and an instructional DVD.
•
JUXTA-CURES™ LEGGINGS: one compression legging, six Velcro® stays, one pair of Comfort Leg Liners™, one pair of Comfort
Compression Anklets™, one BPS™ card, and one disposable paper measuring tape. Five (5) and four (4) packs of Juxta-CURES™
Leggings include one clinician instructional DVD and one patient instructional DVD.
•
CIRCPLUS™ VEIN PROCEDURE COMPRESSION SYSTEM: one Comfort Capri™ and one pair of 30-40 mmHg below-knee elastic
compression stockings.
•
Instructional DVDs are available upon request, unless otherwise noted.
custom compression systems:
•
custom Juxta-Fit™ ARMSLEEVE: one compression armsleeve, elbow band, and one Comfort CoverUp™ and an
instructional DVD.
•
custom Juxta-Fit™ Whole leg: one compression legging, one Comfort Non-Slip Liner™, one pair of Comfort Silver
Thigh-High Socks™ and Comfort Silver Knee-High Socks™, custom knee-cover, one Comfort CoverUp™ , shelf straps (as
needed), and a choice of a Juxta-Fit™ Ankle-Foot Wrap or Juxta-Fit™ Interlocking Ankle-Foot Wrap.
•
custom Juxta-Fit™ UPPER LEG and upper leg with knee leggings: one compression legging, one Comfort
CoverUp™, one Comfort Non-Slip Liner™, one pair of Comfort Silver Thigh-High Socks™ and Comfort Silver Knee-High Socks™,
and shelf straps (as needed).
•
custom Juxta-Fit™ lowER LEG: one compression legging, one pair of Comfort Silver Knee-High Socks™, shelf straps (as
needed) either one pair of Comfort Compression Anklets™ or one Comfort EZ Single-Band Ankle-Foot Wrap™.
•
custom Juxta-Fit™ knee piece: one compression garment, one pair of Comfort Silver Thigh-High Socks™ and one custom
knee-cover.
•
custom Juxta-Fit™ lower leg with knee leggings: one compression legging, one pair of Comfort Silver Thigh-High
Socks™, shelf straps (as needed) either one pair of Comfort Compression Anklets™ or one Comfort EZ Single-Band Ankle-Foot
Wrap™.
•
custom classic-flex™ Leggings: one compression legging, one pair of Comfort Silver Knee-High Socks™ and one
Comfort EZ Single-Band Ankle-Foot Wrap™, foam inserts, an instructional DVD and shelf straps as needed.
•
custom graduate™ Whole leg: one compression legging, one pair of Comfort Thigh-High Socks™, one Comfort
CoverUp™, a pair of gradient measuring cards and an instructional DVD.
•
custom graduate™ below knee legging: one compression legging, one pair of Comfort Knee-High Socks™, a pair of
gradient measuring cards and an instructional DVD.
•
custom measure-up™ armsleeve: one compression armsleeve, two Gradient Measuring Cards, one Comfort Arm
Liner™, one Comfort CoverUp™, one hand cover and an instructional DVD.
•
Instructional DVDs are available upon request, unless otherwise noted.
other garments, foot pieces and ancillary products:
•
Unless otherwise indicated these products are packaged individually.
14
TERMS AND CONDITIONS
SHIPMENTS
Orders will be shipped via UPS, or appropriate, charges prepaid, unless otherwise specified by customer. All U.S. custom garments carry a
guaranteed five day delivery. All domestic standard garment orders totaling $500 or more (pre-discount) will receive free standard shipping.
QUANTITY DISCOUNTS
COMFORT NON-SLIP LINER™: Orders for Comfort Non-Slip Liners™ of four or more will receive a 50% discount off the retail price.
COMFORT SOCK LINERS: Order ten pairs of any Comfort Sock Liner™ (Comfort, Cotton Terry, Silver, Stockinette, Anklet) and receive two pairs free.
RETURNS and Exchanges
All returns must receive advanced authorization from CircAid® Medical Products, Inc. CircAid® will not accept product for return or exchange 30
days after the sale to the customer. A 15% re-stocking fee on all returns that are in salable condition is charged to the customer. Please request a
return authorization number from a CircAid® Customer Service Representative prior to returning product. Once product has been used product
may not be returned or exchanged, excluding returns for manufacturing defects. If determined to be defective, CircAid® will at its discretion
repair or replace the merchandise. Return authorizations may take up to five business days to process. Credits to accounts must be used within
one year of issue date and will be applied to outstanding balances only. Custom-made, special order products, Comfort Non-Slip Liner™ and
Comfort Capri™ cannot be returned or exchanged.
WARRANTY
1.
Juxta-Fit™ Premium Legging Systems: Product is warranted to be free of defects in materials and workmanship. The product will perform
according to and under the stated application and use procedures (including alterations as directed) for a period of one year from the date
the garment is shipped or from the date of purchase for a standard size product. The warranty is only valid if the instructions for care are
followed properly and does not cover normal wear and tear, abnormal care and use, or where it can be shown the application instructions
have not been followed correctly.
2.
Juxta-Fit™ and Juxta-Lite™ Ankle-Foot Wrap: Product is warranted to be free of defects in materials and workmanship. Product will perform
according to and under the stated application and use procedures for a period of 90 days from the date the garment is shipped or from
the date of purchase for a standard size product. The warranty is only valid if the instructions for use and care are followed properly and
does not cover normal wear and tear, abnormal care and use,or where it can be shown the application instructions have not been followed
properly.
3.
Juxta-Fit™ Essentials Leggings, Armsleeve and Glove: Product is warranted to be free of defects in materials and workmanship. The product
will perform according to and under the stated application and use procedures (including alterations as directed) for a period of six months
from the date the garment is shipped. The warranty is only valid if the instructions for care are followed properly and does not cover normal
wear and tear, abnormal care and use, or where it can be shown the application instructions have not been followed correctly.
4.
Graduate™ Whole Leg, BK Graduate™, and Measure-Up™ ArmSleeve Systems: Product is warranted to be free of defects in materials and
workmanship. Product will perform according to and under the stated application and use procedures (including alterations as directed) for
a period of one year from the date the garment is shipped. Products found to be defective after the first six months can be returned for
repair only. The warranty is only valid if the instructions for care are followed properly (hand wash and air dry only) and does not cover
normal wear and tear, abnormal care and use, or where it can be shown the application instructions have not been followed correctly.
5.
Juxta-Lite™ Product will perform according to and under the stated application and use procedures and is warranted to be free of defects in
materials and workmanship. The warranty is only valid if the instructions for care are properly followed; and does not cover normal wear and
tear, abnormal care and use, or where it can be shown the application instructions have not been followed correctly. The warranties are:
6.
•
Juxta-Lite™ Standard Legging: Six months from the date of purchase.
•
Juxta-Lite™ Ankle-Foot Wrap: 90 days from the date of purchase.
•
Comfort Compression Anklet™: Product will be replaced only if there is any manufacturing defect.
Ancillary Products (EZ Single-Band Ankle-Foot Wrap, Gauntlet, Undersocks, Stockinette, Shelf-Strap, Knee Cover, etc.): Product will be
replaced only if there is any manufacturing defect.
TERMS
F.O.B., San Diego, CA. Net 30 for approved accounts, all others C.O.D or credit card. Visa, MasterCard, and American Express accepted. Please
request an Account Setup form or Credit Application from Customer Service for establishing an account. Orders shipped outside of the USA are
payable in advance in U.S. dollars by draft on a U.S. bank.
PRICES SUBJECT TO CHANGE WITHOUT NOTICE. MSRP prices may vary due to geographic location, local fitting services, shipping expenses, etc.
Physician Prescription Required for all custom products.
CircAid Medical Products, Inc., assumes no liability for injury or damages resulting from contraindicated use of its products. CircAid is a Registered
Trademark and Juxta-CURES, Compression Ulcer Recovery System, Juxta-Fit, Juxta-Lite, Graduate, Measure-Up, Classic-Flex, Ready-Fit, Comfort
Capri, Comfort Non-Slip Liner, Comfort CoverUp, Comfort Cotton Terry Knee-High Sock, Comfort Cotton Terry Thigh-High Sock, Comfort Arm
Liner, Comfort Leg Liner, Comfort Knee-High Sock, Comfort Thigh-High Sock, Comfort Silver Arm Liner, Comfort Silver Knee-High Sock, Comfort
Silver Thigh-High Sock, Comfort Arm Stockinette, Comfort Thigh-High Stockinette and Comfort Knee-High Stockinette are trademarks of CircAid
Medical Products, Inc. Breath-O-Prene is a registered trademark and SILVERtec is a trademark of AccuMED Technologies, LLC. Lycra is a registered
trademark of INVISTA. Velcro is a registered trademark of Velcro USA, Inc. ©2012 CircAid Medical Products, Inc. All rights reserved.
Need more order forms or sizing charts?
Call us at:
Email us at:
Fax us at:
9323 Chesapeake Drive, Suite B2 · San Diego, CA 92123
© 2012 CircAid Medical Products, Inc. All rights reserved.
CA-FB-052512-01

CircAid Forms - 12 pages

Transcription

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