Lower Extremity Prosthetic Fabrication

Metal AFO Fabrication
DMU
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Practitioner:*
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Due Date:

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Metal AFO Fabrication

Patient Information
Affected Side:*

LeftRight
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Metal AFO Fabrication

Measurements
Left - Measurements:*
Right - Measurements:*

Metal AFO Fabrication

Notes
I would like a phone call to discuss this project prior to starting fabrication:

Yes
Notes (include any shoe modifications and additional requests here):

0/50
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