Underarm Crutch Order Form
(Print this page to mail with your order and tracing)
Getting the correct measurements to order custom made crutches is easier than you might think. Your most important assignment is to carefully read and understand the instructions and fill in all the information requested. Let's start with the simple stuff.
Name______
Street Address______
______
Important Note: We ship via UPS so we must have a street address.
City______
State______Zip Code______
Country______Daytime Phone (______) ______
E-mail ______
Credit Card #______Expires______
Now for the personal part...this info I use to equate with your crutch measurements. I will call you if I sense something is not right.
Your Height ______Weight ______Age______
Mobility: Walking Gait ___ Swing Through Gait ___
Activity level: Check one of the following that fits you best.
___ Gorilla: You are big, strong and athletic. You regularly go hunting, fishing, hiking, climbing, go up two stairs at a time, etc. and it seems like you break your crutches all the time.
___ Draft Horse: You regularly go out everyday to work or for walks, go food shopping, do house chores, go to movies and travel.
___ Pussy Cat: While you may have once been an adept and agile hunter in the wild, you now spend most of your time lounging around your home sitting in the sun reading a good book.
A full size tracing for all Underarm crutch orders is required.
Mail Tracing to:Thomas Fetterman Inc.
637 N. 12th St., Rear
Philadelphia, PA19123
Standard Underarm Crutches Measurement X ______Measurement Y ______
Performance Rain Tips Tornado Rain Tips ____
Rubber Underarm Pads Slim Line Underarm Pads ____
Natural Luster____ Powder Coat Black ____
Shepherds Crutch Measurement X ______Measurement Y ______
Performance Rain Tips Tornado Rain Tips ____
Performance Hand Grips: MountForward_____MountReverse ____
Natural Luster Powder Coat Black .
Unipoise Crutch Measurement X ______Measurement Y ______
Performance Rain Tips Tornado Rain Tips ____
Performance Hand Grips: MountForward_____MountReverse ____
Rubber Underarm Pads Slim Line Underarm Pads ____
Natural Luster Powder Coat Black ____
Handle position shown for both Shepherds and Unipoise crutches.
Handle Mounted Front Facing Handle Mounted Rear Facing