RMS AFO Order form RMS AFO Customer Clinician Patient ID Reorder Order/project reference Include Production Model Weight (kg) Activity Level K1 K2 K3 K4 Side Left Right Reliefs/buildup Malleoli Medial Malleoli Lateral Heel height 10mm Other Other mm Dorsi Flexion: No change Neutral Other Other Degrees Function Dropfoot prevention Foot alignment Varus/valgus stability Design Frame Open Malleoli File Upload Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Notes If you are human, leave this field blank. Order Δ
