Form 2, Form 3 - Hands And Arms - Voe, S.a. Page 2
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1
2FORM Nº3
VOE, S.A.
Aribau, 39. 08011 Barcelona (Spain)
Tel. +34 93 451 64 52
Fax +34 93 451 76 22
info@voe.es
Date:
Nº:
Patient:
Age*:
Male
Female
Weight*:
Height*:
Replacement
IMPORTANT: You must attach a picture of injury or draw it in the sketch. *Required data.
Vest
Nº units.:
Nº units.:
Nº units.:
Nº units.:
Nº units.:
Ref. 9206
Ref. 9201
Ref. 9202
Ref. 9207
Arm sleeve with glove in
Arm sleeve
Arm sleeve and shoulder
Arm sleeve and shoulder
Without sleeves
Ref. 9101
one piece
R
L
Short sleeves
Ref. 9111
Closed
Open
D
I
Closed
Open
Ref. 9121
Long sleeves
Mitt
Mitt
Fill form nº 2 (gloves)
Fill form nº 2 (gloves)
Basic Measurements
R
L
Additional measurements
16
1
Lenght
Arm circumference
1
Circumference of neck
(from wrist) each
12
11
R
L
5 cms.
10
Circumference of chest under armpit
2
2
18
17
6
14
3
Circumference of under breast perimeter
3
7
Circumference of waist
4
13
4
5
Circumference of hips
15
8
5
Circumference of arm
6
9
7
Circumference of elbow
Circumference of 1/2 forearm
8
9
Circumference of wrist
Comments
Fastening
10 Armpit perimeter
Front
Rear
11
Distance from shoulder to waist (front)
Velcro
Zip
12 Distance from shoulder to breast
Very open
Height
13 Inside lenght to arm
High neck
14 Outside lenght to arm
Additional measurements for women
15 Lenght from wrist to elbow
Perimeter on nipple line
Bra size
16 Width of shoulder
17 Distance from shoulder to wait (rear)
18 Distance from shoulder to end of garment
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