Work Order: Arizona AFO

There are two methods ordering depending on the way you are submitting your order:

METHOD #1

If you have a cast of your patients foot you MUST download the work order to fill out and mail in along with the cast.

Download the Work Order: Arizona AFO Form

METHOD #2

If you have a scan of your patients foot, please fill out the electronic work order below and attach your scan file in the space provided.  For more information on submitting scans, CLICK HERE.  Otherwise, continue to submit your scan order below.

NOTE: If you have a scanned file of your patients foot, please attach your Scan File and fill out the electronic work order below. For more information see Submit Scans.
Attach Scan*:
Standard
Tall
Unweighting
Extended
Sporty
Partial Foot
5" above ankle
9" above ankle
Proximal Ht.
1" below fibular head
5" above ankle
Send shoe with cast
Joint Selection:
Tamarack Free
        Motion
Tamarack
        Dorsi-Assist
Plantar Stop
Articulated
ARTICULATED STYLE:
Standard
Tall
Extended
COLOR:
Sand
Black
Brown
White
Other (If available)  
CLOSURE:
Laces
Velcro
Boot Hooks
Speed Laces
Additional Charge Options:
Foot trim length to end of toes
Removable, multi-density insole

Patient Information

First Name*:
Last Name*:
PO#*:
Male Female
Foot Choice*:
DX*:
Age:
Height*:
Weight*:

Shipping and Billing Addresses

Practitioner*:
Email*:
Phone*:
Fax:
Facility Name*:
Ship To:
Bill To:

Manufacturing and Shipping

MFG:
3 Day Rush ($75.00) 7 Day Rush ($50.00) (Rush Services not available on Partial Foot AFO)
SHIP*:
Ground 3 Day Air 2 Day Air Overnight Other  

Special Instructions

If you do not want the dorsi/plantar angle of the cast set to our recommendations, then please choose:
Leave cast exactly as is Correct ankle Varus/Valgus Correct forefoot to neutral
Comments  
(If ankle and/or forefoot are correctable, it is highly recommended that you capture that at the time of casting to obtain best results)