• Transfemoral Check Socket Order Form v5.3

    Transfemoral Check Socket Order Form v5.3

    Standard Fabrication 1-3 Business Days
    • Account Information 
    • Order Information 
    • Today's Date
       - -
    • Requested Due Date*
       - -
    • May we proceed with fabrication or is the Job on HOLD?
    • Design 
    • Socket Design*
    • Browse Files
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    • Image field 38
    • If a Discrepancy Exists, Go By*
    • Units of Measure*
    • Rows
    • Socket 
    • Plastic Type*

    • Vacuum Forming Method*
    • Plastic Thickness*

    • Insert 
    • Custom Insert Material

    • Insert Thickness*

    • Add Ons

    • End Pad Material

    • End Pad Thickness*

    • Removable End Pad*
    • Suspension 
    • Shuttle Lock

    • TSB

    • Elevated Vacuum

    • Lanyard

    • Components 
    • Support Structure
    • Componentry
    • Component Material
    • Pylon Diameter
    • Socket Attachment

    • Attachment Shape
    • Attachment Rotation
    • Finishing 
    • Guidelines
    • Trimlines
    • Setup/Alignment 
    • Set Up

    • Socket Flexion Angle

    • Socket Coronal Angle

    • Rotation of Leg
    • AOPS Billing 
    • Should be Empty: