Ossur - Life Without Limitation

You are here: Braces & Supports » Ordering Information » On-line CTi Custom Knee Brace Order form

On-line CTi Custom Knee Brace Order form

Order form for US customers.

1. Bill To

Customer# *:
PO# *:
Company*:
Address 1:
Address 2:
Address 3:
City*:
State*:
Zip/Postal Code:
Country:
Contact Name:
Phone*:
Fax:
Email:
	A confirmation of your order will be sent to this email address.

2. Ship To

Same as Bill To:
Company Name*:
Contact Name:
Address 1:
Address 2:
Address 3:
City*:
State*:
Zip/Postal Code:
Country:
Phone*:
Shipping:	$50 Rush Service (3 Day Rush Service)

3. Patient Information

4. Model

High Contact, High Impact	Pro-Sport
Moderate to High Contact, Moderate to High Impact	Standard
Low to Moderate Contact, Low to Moderate Impact	Vapor

Add to any Model		PCL opposing femoral cuff and gastroc force plate *
		OA for unicompartmental osteoarthritis *
		Medial Lateral
		Super Short
		(Recommended for for 5'3" or less)
*Additional Cost


Extension Stops	degrees

Options	ACL Cable System*
	(Additional pretection for ACL instabilities)
	Ski Boot Attachment**
	(Provide "Ski Boot Measurement" below)
	Prep for Ski Boot Attachment**[No Charge]
	(Patient Able to use the attachment in the future)
	(Provide "Ski Boot Measurement" below)

	Ski Boot Measurement inches from the distal border of the patella to the top of the ski boot. Attachment not available if the measurement is less than 7 inches.


	Flexion Stop Kit

Accessories	Sofsleeve*
	CoolMax Sofsleeve
	Neoprene Undersleeve
	Neoprene Oversleeve
	Padded Sports Oversleeve
	Sportsleeve
	Hyperextension Strap
	Patella Cup*
	Motocross Kit

	Anti-Migration System Y-Wrap
	EVA 50 Neoprene
	(Patella cup, gear guards, MX undersleeve and stickers)
	Gear Guards

5. Paint Options

Standard Colors:
Custom Designs:
Other:
Optional Picture file to upload:

6. Special Conditions

Degree Varus:
Degree Valgus:

Prominent:	VMO	VLO
	Hockey Quads
	Prominent Tibialis Anterior
	Prominent fibularhead
	RTM [Rounded Tibial Member]
	Osgood-Schlatters Disease
	Shorten Femoral Component
		0.5" 1.0" 1.5"
	Shorten Tibial Component
		0.5" 1.0" 1.5"

Special Instructions:

Have a tech contact me prior to fabrication
Name:
Phone:

Select an ΔOP/DMS file to upload:

Select an ΔOP/DMS pictures to upload:

You are also welcome to contact our Customer Service for any assistance:

27412 Aliso Viejo Pkwy
Aliso Viejo, CA 92656
USA
Tel: + 949 362 3883
Fax: + 949 362 3888

ossurusa@ossur.com

Sports Medicine & Extremity
Tel: + 800 222 4284
Fax: + 800 453 4567

Trauma & Spine
Tel: + 800 257 8440
Fax: + 856 848 0531
spine@ossur.com

Podiatry & Retail
Tel: + 800 521 0601
Fax: + 800 284 4356