Name Age Height (ins.) Weight (lbs.) Sex Male Female Diagnosis Phone # Affected Leg Right Left Instability/Deficiency ACL PCL CI MCL/LCL/Meniscus Patellofemoral Pain None Osteoarthritis Medial Compartment Lateral Compartment
Magnesium Aluminum Short 13" Standard 15" Short 14" Standard 16" Short 16" Standard 17" Standard 13" Extended 15" Standard 11" Extended 13" Degrees of Offset
"D-Ring" Strap Style Undersleeve Quantity Flexion/Extension Stop Kit PCL Strap Oversleeve Quantity AFO Attachment Patella Guard Patella/Femoral Guard
Everyday High Activity Brace for Axiom, Z-12, and DUO braces Ultrasuede brace for Axiom braces Quantity of Additional Pads
Jet Black Black Metallic Silver Metallic Traffic Blue Pastel Blue Wine Red Steel Blue Water Blue Ultramarine Blue Moss Green Grass Green Yellow Green Signal Yellow Sahara Gold Pure Orange Traffic Red Traffic White Telemagenta