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Topcfinc.com CUSTOMER INFORMATION ORDER DATE DATE NEEDED FACILIT PO PRACTITIONER ADDRESS CITY/STATE FAX EMAIL SHIPPING INFORMATION NEXT DAY AIR 2ND DAY AIR 3RD DAY AIR GROUND PATIENT INFORMATION NAME MALE AGE HT WT L R B FABRICATION INSTRUCTIONS TYPE OF AFO Resting AFO Solid AFO Unloader AFO CAST CORRECTIONS Leave as casted Correct cast to 90 Other SOLE STYLE Rocker sole standard Rocker sole/medial wedge All measurements must be provided and wounds should be marked on the above illustration....
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To fill out gauntlet AFO39's order form, follow these steps:
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Gauntlet AFO39's order form is required by individuals or medical professionals who intend to purchase or prescribe gauntlet AFO39's. The form ensures that the correct specifications, quantity, and customization options are taken into account when fulfilling the order or prescription.
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Gauntlet afo39s order form is a document used to place an order for gauntlets.
Customers or individuals who wish to purchase gauntlets are required to file gauntlet afo39s order form.
To fill out gauntlet afo39s order form, you need to provide your contact information, order details, and payment information.
The purpose of gauntlet afo39s order form is to facilitate the purchase of gauntlets by providing a structured way to submit orders.
The information that must be reported on gauntlet afo39s order form includes the type of gauntlet, quantity, size, color, and any customization options.
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