JoviPak Custom Hip Hugger Options Form

JoviPak Custom Hip Hugger Options Form

Hip Hugger™ Options Form
e-to-Order
Made-to-Order and Cus tom
®
Upper Leg Form
Patient's Name
Polartec®
ower Dry®
Only
Cotton/Lycra®
Only
FABRIC
Cotton/Lycra®Cotton/Lycra
Ivory
Boxer
� LE-DM-HH
LE-DM-HH
HipHipHugger
Hugger
LE-FM-BXR-JJ�
LE-AG-JJ
LE-DG-JJ
Length
ThighFull
Cylinder
JoVi Jacket
JoVi Jacket when
�w/Black
worn
Lower Leg
JoVi� White
� Royal Blue � Ivory
Grey
Large
Buff
XLarge
Black
2XLarge
Navy
Royal
Blue Measurements
Length
Medial Inseam (FloorNOTE:
to Groin)
Leaf Green
garments
69 cm
27 in
� Short
Purple Heart
returnable.
®
Made-to-O
are
If the u
leg 29
measurem
do not
31 fall within
White
circumferential and le
33
parameters,
use the Cus
Short 69cm
(27”)
LE-AG-JJ
JoViJacket
™ Pink (odor-resistant fiber)
(Made-to-Measure) Form
Full Length74cm
JoViJacket
when worn with
Regular
(29”)
submit measurements
�® Made-to-Order
Lower Leg JoViPak® Garment Polartec® Power Dry
each landmark. If orde
Long�
79cm
(31”)� White
w/ X-Static® Fiber � Customa LE-DG1 with adjust
Black
opening,
XLong 84cm (33”)
Glacier Blue
Leaf Green Velcro ®
recommend Cotton/Ly
Indigo Blue
� Rightfabric. Alterations are b
NOTE: IF the Hip Hugger is being worn with
� Left at $60 per hour.
SIZES
� Regular 74
Glacier Blue
79
� Long
French Blue
� XLong 84
lower leg garment, go to page 30 or 32 for
Rightto:and
Left
more information.
Fax this form Toll�Free
1-877-760-4943
XSmall
with standard JoViPak Order Form
with Shipping and Billing Instructions
Small
ket Color:
Royal Blue
Polartec® Power Dry®
LENGTH
Size (Refer to pg 38)
Length
measurements�
� XSmall
for the Thigh Cylinder
and
Hip Hugger are�
�the
Small
based on the Medial
� Medium
In-seam
– Floor (A�
landmark) to Groin (G
landmark).
LE-FM-BXR
Color Options
JoViPak® Declares War on
Swollen Hips!
Medium
Large
XLarge
ht
Male
Female
2XLarge
Fitter/
Therapist
Clinic/
DME
on/Lycra LE-DG1 only)
by waist size)
Medium (36"- 46")
XLarge (56"- 66")
Comment
Patient Name
or Reference#
NOTE: Two Hip Huggers may be an alternative to the
Phoneproviding
Boxer Short if an open crotch is required
outh, Suite B101,there
Kent, Washington
98032
is no genital
swelling. Choose "Right and Left"
Email: [email protected], Website: www.jovipak.com
option. (See three photos above.)
fAX this form Toll Free to:
1-877-760-4943 with Date
Measurements (pg 40), and
Hip Hugger Garment Order Form (pg 41)
®
Downloadable order forms at www.jovipak.com
39 April 16th, 2010
Phone Toll Free (US): 1-866-888-JOVI