Thrive Orthopedics Digital Order Form
All questions with a red asterisk are required
What type of customer are you?
*
Existing customer (We've ordered before)
New customer (This is our first order)
Customer Name
*
First Name
Last Name
Customer Email
*
example@example.com
Customer phone number
*
Please enter a valid phone number.
Clinic Information
Clinic Name
*
Clinic Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Enter Suite #, Attention To, or N/A
*
Purchase Order
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Order Form
My Products
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Categories:
All
All
Bracing
Carbon Fiber Foot Plates
Accessories
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Name: A to Z
Name: Z to A
Price: Low to High
Price: High to Low
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( X )
Bracing
F3 Anterior AFO
$
Free
Size
Straps
Quantity
XS - LT
Velcro
Magnetic loops
XS - RT
Velcro
Magnetic loops
S - LT
Velcro
Magnetic loops
S - RT
Velcro
Magnetic loops
M - LT
Velcro
Magnetic loops
M - RT
Velcro
Magnetic loops
L - LT
Velcro
Magnetic loops
L - RT
Velcro
Magnetic loops
XL - LT
Velcro
Magnetic loops
XL - RT
Velcro
Magnetic loops
F3 Anterior FlexTrim AFO
$
Free
Size
Straps
Quantity
XS - LT
Velcro
Magnetic Loop
XS - RT
Velcro
Magnetic Loop
S - LT
Velcro
Magnetic Loop
S - RT
Velcro
Magnetic Loop
M - LT
Velcro
Magnetic Loop
M - RT
Velcro
Magnetic Loop
L - LT
Velcro
Magnetic Loop
L - RT
Velcro
Magnetic Loop
XL - LT
Velcro
Magnetic Loop
XL - RT
Velcro
Magnetic Loop
F5 Lateral
$
Free
Size
Straps
Quantity
XS - LT
Velcro
Magnetic loops
XS - RT
Velcro
Magnetic loops
S - LT
Velcro
Magnetic loops
S - RT
Velcro
Magnetic loops
M - LT
Velcro
Magnetic loops
M - RT
Velcro
Magnetic loops
L - LT
Velcro
Magnetic loops
L - RT
Velcro
Magnetic loops
XL - LT
Velcro
Magnetic loops
XL - RT
Velcro
Magnetic loops
F5 Lateral FlexTrim AFO
$
Free
Size
Straps
Quantity
XS - LT
Velcro
Magnetic Loop
XS - RT
Velcro
Magnetic Loop
S - LT
Velcro
Magnetic Loop
S - RT
Velcro
Magnetic Loop
M - LT
Velcro
Magnetic Loop
M - RT
Velcro
Magnetic Loop
L - LT
Velcro
Magnetic Loop
L - RT
Velcro
Magnetic Loop
XL - LT
Velcro
Magnetic Loop
XL - RT
Velcro
Magnetic Loop
F5 Medial AFO
$
Free
Size
Straps
Quantity
XS - LT
Velcro
Magnetic loops
XS - RT
Velcro
Magnetic loops
S - LT
Velcro
Magnetic loops
S - RT
Velcro
Magnetic loops
M - LT
Velcro
Magnetic loops
M - RT
Velcro
Magnetic loops
L - LT
Velcro
Magnetic loops
L - RT
Velcro
Magnetic loops
XL - LT
Velcro
Magnetic loops
XL - RT
Velcro
Magnetic loops
Item subtotal:
$
0.00
UFO-51 Universal AFO
$
Free
Side
Straps
Quantity
LT
Velcro
Magnetic loops
RT
Velcro
Magnetic loops
F3 Hero Pediatric AFO
$
Free
Size
Straps
Quantity
S - LT
Velcro
Magnetic loops
S - RT
Velcro
Magnetic loops
M - LT
Velcro
Magnetic loops
M - RT
Velcro
Magnetic loops
L - LT
Velcro
Magnetic loops
L - RT
Velcro
Magnetic loops
XL - LT
Velcro
Magnetic loops
XL - RT
Velcro
Magnetic loops
The Equinus Brace
$
Free
Size
Quantity
Universal Pediatric (Toddler 8 - Little Kids 2)
Universal Adult (W6-M11)
Universal XL (M11-M16)
Jetlace Ankle Brace
$
Free
Size
Quantity
XS
S
M
L
XL
Mach8 Ankle Brace
$
Free
Size
Quantity
XS
S
M
L
XL
Carbon Fiber Foot Plates
X Glide Rigid, Flat
$
Free
Size
Quantity
W5 - 213mm
W6 - 223mm
W7 | M6 - 233mm
W8 | M7 - 243mm
W9 | M8 - 253mm
W10 | M9 - 263mm
W11 | M10 - 273mm
W12 | M11 - 283mm
W13 | M12 - 293mm
M13 - 302mm
M14 - 312mm
M15 - 322mm
M16
X Glide Flexible, Flat
$
Free
Size
Quantity
W5 - 213mm
W6 - 223mm
W7 | M6 - 233mm
W8 | M7 - 243mm
W9 | M8 - 253mm
W10 | M9 - 263mm
W11 | M10 - 273mm
W12 | M11 - 283mm
W13 | M12 - 293mm
M13 - 302mm
M14 - 312mm
M15 - 322mm
X Glide Rigid, Morton's Extension
$
Free
Size
Quantity
W5 - 213mm
W6 - 223mm
W7 | M6 - 233mm
W8 | M7 - 243mm
W9 | M8 - 253mm
W10 | M9 - 263mm
W11 | M10 - 273mm
W12 | M11 - 283mm
W13 | M12 - 293mm
M13 - 302mm
M14 - 312mm
M15 - 322mm
X Glide Flexible, Morton's Extension
$
Free
Size
Quantity
W5 - 213mm
W6 - 223mm
W7 | M6 - 233mm
W8 | M7 - 243mm
W9 | M8 - 253mm
W10 | M9 - 263mm
W11 | M10 - 273mm
W12 | M11 - 283mm
W13 | M12 - 293mm
M13 - 302mm
M14 - 312mm
M15 - 322mm
Pediatric X-Glide Rigid, Flat
$
Free
Size
Quantity
Kid's Size 5 - 121 mm
Kid's Size 6 - 130 mm
Kid's Size 7 - 140mm
Kid's Size 8 - 146 mm
Kid's Size 9 - 156 mm
Kid's Size 10 - 165 mm
Kid's Size 11 - 171 mm
Kid's Size 12 - 181 mm
Big Kid's Size 1 - 191 mm
Pediatric X-Glide Flexible, Flat
$
Free
Size
Quantity
Kid's Size 5 - 121 mm
Kid's Size 6 - 130 mm
Kid's Size 7 - 140 mm
Kid's Size 8 -146 mm
Kid's Size 9- 156 mm
Kid's Size 10 - 165 mm
Kid's Size 11 - 171 mm
Kid's Size 12 - 181 mm
Big Kid's Size 1- 191 mm
X-Glide Rigid, Contoured
$
Free
Size
Quantity
S - 228mm
M - 253mm
L - 280mm
XL - 308mm
X-Glide Flexible, Contoured
$
Free
Size
Quantity
S - 228mm
M - 253mm
L - 280mm
XL - 308mm
Accessories
Essentials Kit
$
Free
Size
Quantity
Style
XS
F3
F5
S
F3
F5
M
F3
F5
L
F3
F5
XL
F3
F5
Magnetic Straps
$
Free
Size
Quantity
1.5" Width (2 straps)
1.0" Width (2 straps)
1.5" and 1.0" Width (2 straps)
T-Strap
For F5 Medial, please select T-Strap opposite of the side that the AFO was ordered for. For example, for a Medial Left, select a Right T-Strap.
$
Free
Side
Quantity
Left
Right
Back
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Special instructions or delivery notes:
Accounts Payable Information
Accounts payable address same as shipping address?
Yes
No
Accounts Payable Address
Suite # (if applicable)
Accounts Payable Contact Name
*
First Name
Last Name
Accounts Payable Contact Phone Number
*
Please enter a valid phone number.
Accounts Payable Contact Email
*
example@example.com
Upon receipt of this form, a credit agreement will be sent to the AP contact above. Thank you for your submission!
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