SDO Pro-Tem Order Form Product List Please take the following single circumference for the garment required If you wish to order the SDO Pro-Tem Garment, please fill in your order and delivery details below: Garment Code 1: Waist Lumbar Support PCP21 Depth: 18 front Paediatric 54–80 Lumbar Support PCP22 Adult Depth: 20 front 71–103 Sleeve PCP63 9–13 PCP63 12–16 PCP63 15–19 PCP63 16.5 –20.5 PCP63 18–22 PCP63 22–27 Glove, Open Tips PCP64 11–14 PCP64 13–16 PCP64 15–18 PCP64 17–21 PCP64 20–25 PCP69 11–14 PCP69 13–16 PCP69 15–18 PCP69 17–21 PCP69 20–25 PCP70 13–15 PCP70 14–18 PCP70 16.5 –20 PCP70 19–23 PCP70 20–25 2: Wrist Order and delivery details Order date: Order number: 3: Palm Clinicians name: Organisation/Hospital: Circumference (cm) Measure point 4: Palm Gauntlet Department: 5: Ankle Sock (above malleoli) Address: 6: Chest *Ax Suit Quantity PCP71 39–49 Paediatric Post code: PCP71 49–59 Paediatric Direct contact no: PCP71 59–69 Paediatric PCP71 69–79 Paediatric Please Note: No modifications are available to the SDO Pro-TEM range of garments Please indicate in the quantity box on the right how many of each item you wish to order and fill in the delivery details above PCP71 Adult 74–84 PCP71 Adult 84–94 PCP71 Adult 94–104 *Front Ax Suit Front of suit is standard two layers of fabric Please send your order to us using the following: Fax: Email: Telephone: Post: +44 (0) 115 973 3902 [email protected] +44 (0) 115 973 4300 Unit 13a Harrington Mill, Leopold Street, Long Eaton, Nottingham, NG10 4QG, UK To download additional order forms please visit www.jobskin.co.uk 02893_©Jobskin Pro-Tem v3 10/2013 JSIFU085
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