Custom Method TA AFO

Print PDF Order Form

Patient Information

Practitioner Shipping Information

Order Information

Device Selection

Single Upright Flat Footplate
Include Custom Foot Orthotic

Order Information

Ship the cast with this completed order form to:

Becker Orthopedic Central Fabrication
574 Robbins Dr.
Troy, MI 48083

Up to 12 files can be uploaded.

Foot Orthotic Options

All Top covers in Black Puff 1/16" + 1/16" PPT

All Top covers P-cell 1/8" + PPT 1/16"

Include MetPad

Posting

Left Side
Forefoot
°
°
Rearfoot
°
°
Right Side
Forefoot
°
°
Rearfoot
°
°

Measurements

  • Confirm that the patient's calf circumference is less than 40cm [16 inches]
  • Confirm that the finished AFO height is less than 40cm [16 inches]
Left Side
in
in
in
in
in
Right Side
in
in
in
in
in
Additional Accessories