Custom Fabrication Order Forms

Custom Fabrication Order Forms

Definitive Socket Order Form
To order a transtibial or transfemoral socket, save the form to your computer, complete it, and then print the order form. Fax the order toll-free to 800.878.4858 or e-mail the order to customerservice@owwco.com. Please be sure to complete all information on the form.  Form includes AK by Measurement information. View available transfemoral brim shapes.

Test Socket Order Form 
Save the order form to your computer, complete the form and then print it to order a transtibial or a transfemoral test socket. Be sure to include the form with the plaster cast. If sending a shape file from OMEGA® please fax the form to 888.878.4858 . Please be sure to complete all information on the form.

Alpha DESIGN® AK Liner Order Form
Complete the order form and press the “Print” button at the bottom. Include one copy with the cast of the residual limb only. Missing information may delay your order. Please fill out the form accurately. For bilateral amputees, please complete separate forms for each residual limb.

Alpha DESIGN® BK Liner Order Form
Complete the order form and press the “Print” button at the bottom. Include one copy with the cast of the residual limb only. Missing information may delay your order. Please fill out the form accurately. For bilateral amputees, please complete separate forms for each residual limb.

WillowWood One System with LimbLogic® Definitive Socket Order Form
WillowWood One System – Suction Definitive Socket Order Form
After determining the alignment, send the diagnostic socket for the WillowWood One System to WillowWood for fabrication of the removable brim and definitive socket. Save the writable order form PDF for the selected suspension method (LimbLogic or suction) to your computer, complete the form, and print. Include the completed order form with the diagnostic socket. Please be sure to complete all information on the form.

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