• UCB Order Form v5.3

    UCB Order Form v5.3

    Standard UCB Fabrication 4 Business Days
    • Account Information 
    • Order Information 
    • Today's Date
       - -
    • Requested Due Date*
       - -
    • Device 

    • Modification*

    • Standard Modifications Include:

      • Square and leveled plantar surface - Calcaneal roundness is maintained
      • 3 mm (1/8") build-up to navicular and calcaneal tuberosity
      • Arches at plantar surface are not modified
      • 3 mm build-up added to marked bony areas

    • Minimal Modifications Include:

      • Square and leveled plantar surface - Calcaneal roundness is maintained
      • 3 mm (1/8") build-up to navicular and calcaneal tuberosity
      • Plantar surface of cast modified to ~1/4" depth
      • 3 mm build-up added to marked bony areas
    • Design 
    • Hindfoot Correction*

    • Forefoot Correction*

    • Increase Arch*

    • Posting
    • Posting Location*

    • Hindfoot Post Location*

    • Hindfoot Post Material*
    • Hindfoot Post Profile*


    • Forefoot Post Location*

    • Forefoot Posting Material*
    • Metatarsal Bar
    • Metatarsal Bar Depth*
    • Metatarsal Pad
    • Metatarsal Pad Depth*
    • Forefoot Coverage*

    • Midfoot Coverage*

    • Foot Plate Length*
    • Dorsal Flaps
    • Thermoforming 
    • Plastic Type*

    • Plastic Thickness*

    • Color*
    • Lining/Padding Location
    • When to Pad*
    • Padding Material*

    • Padding Thickness*
    • Additional Instructions 
    • Guidelines
    • Anatomical Measurements 
    • If a Discrepancy Exists, Go By*
    • Units of Measure*
    • AOPS Billing 
    • Should be Empty: