PHYSICIAN ORDER FORM
Bill To Address
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Physician Name
Physician Name
Street Address
Street Address
 Suite
Suite
City
City
 State
 State
Zip
 Zip
G
C
 D
 E
 F
 H
A
 B
 QTY.
 DISCOUNTS
1-     35 Prs.          0%
36-    72 Prs.        10%
73-  143 Prs.        15%
144-288 Prs.        20%

CREDIT CARDS     5%  
             
Redi-Thotics FLEX
Redi-Thotics SLIM
Redi-Thotics CONTROL
Redi-Thotics MAX
Redi-Thotics ULTRA
Redi-Thotics QUIK-FORM
 BALANCE 3/4        
BALANCE FULL LENGTH       
XS
 S
 M
 L
XL
 TOTAL
Redi-Thotics KIDS AWESOME
Orders in boxes of 12 packs
Redi-Helperz  Met Pads Sm.
Redi-Helperz  Redi-Steppers
Redi-Helperz  Met Pads Lg..
Redi-Helperz  Soft-Spots
Redi-Helperz Arch Cookies
Redi-Helperz  Redi-Grippers
Boxes
Degrees
Redi-Helperz Posts
3, 4, 5 degrees
Redi-Helperz  Safe-Grips
                                                                      ADULT SIZING CHART

                                    A           B            C                 D                  E                 F                G                  H
            Mens            5-6.5     7-7.5        8-8.5          9-9.5          10-10.5        11-13        13.5-15        15.5-17
           Womens       6-7.5     8-8.5        9-9.5        10-10.5        11-11.5        12-14        
           European     35/36    37/38       39/40          41/42           43/44         45/47          48/49           50/51      
                                 KIDS SIZING CHART

                            XS          S         M        L        XL
                             8-9      10-11  12-13    1-2      3-4
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