FACIAL/NECK PAD P: 866.931.0876 F: 866.931.0052 Measure & Order Form [email protected] PO#: Date: Company: Phone: Contact Name: Patient: Sex: Age: Ht: Wt: Bill-To Name & Address: Ship-To Name & Address: PRODUCT INFORMATION SIZE: PAD: SMALL LARGE MEDIUM Item # 2950: Neck/Cranial Item #2940: Neck/Mandible ACCESSORIES (additional cost): Velcro extender (5cm additional circumferencial range) Qty. SIZING CHART Head Circumference Neck Circumference X - LARGE SMALL 53 - 56 MEDIUM 56 - 58 LARGE 58 - 61 X - LARGE 61 - 64 28 - 33 33 - 38 38 - 43 43 - 58 Head Circumference (measure 1/2” above eye brow) Neck Circumference (measure at largest part of neck) BiaCare.com • P: 866.931.0876 • F: 866.931.0052 46
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