We had many distinguished visitors, but what you do makes more of a difference than all the efforts of those other people combined!
Col. Thomas M. Rice USAF
859th D&T Squadron, Lackland AFB, TX
Individual Adaptive Clothing Request
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Select One
Outside the US
AE
Alabama
Alaska
AP
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Ohio (Center)
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Z-Special CA
Zip:
Phone:
-
-
E-Mail Address:
(contact for questions)
Hospital Location
(if applicable):
Branch of Service:
Indicate Clothing Needs:
You may select as many types and quantities that you need.
See the
Adaptive Clothing
page for descriptions and pictures of the clothing.
SHIRTS
Sizing: Small 34" - 38" Medium 38" - 42" Large 42" - 46" X-Large 46" - 50" XX-Large 50" - 54"
Shirt Adaptations - indicate for all shirt orders:
Adaptation on:
Right
Left
Double
Size:
Small
Medium
Large
X Large
2X Large
3X Large
4X Large
Type:
(solid, sport team, etc.)
T-Shirt:
Torso adaption
(sides only)
Qty:
Shoulder Adaption
(shoulder and sides)
Qty:
Long Sleeve T-Shirt:
Torso adaption
(sides only)
Qty:
Shoulder Adaption
(shoulder and sides)
Qty:
Polo Shirt:
Torso adaption
(sides only)
Qty:
Sweat Shirt:
Torso adaption
(sides only)
Qty:
Shoulder Adaption
(shoulder and sides)
Qty:
Button down shirt:
(velcro closure w/buttons in place)
Button down shirt:
Qty:
Halo shirt:
Qty:
Special Shirt Requests
(indicate neck and arm measurements if ordering Button down shirts):
PANTS
sizes are: small 28" - 31.5" Medium 32" - 35.5" Large 36" - 39.5" XLarge 40" - 43.5" XXLarge 44"- 47.5" each pant has waist and inseam listed on the size tags
Pants Adaptations - indicate for all pants orders:
Adaptation on:
Right
Left
Double
Size:
Small
Medium
Large
X Large
2X Large
3X Large
4X Large
Type:
Casual Dress
Lounge
Color preference:
Fixator
:
Qty:
FLAP
:
Qty:
Wheelchair Pant
:
Qty:
Sweat Pant
:
Qty:
SHORTS & UNDERGARMENTS
Shorts Adaptations – indicate for all shorts and undergarments orders:
Adaptation on:
Right
Left
Double
Size:
Small
Medium
Large
X Large
2X Large
3X Large
4X Large
Color preference:
Athletic Shorts
:
Qty:
Casual Dress
:
Qty:
Swim Suits
:
Qty:
Boxers
:
Qty:
Female Undergarments
:
Qty:
Additional Information:
(Other information we should know so we can complete request for you)
COMFORT ACCESSORIES
Bedrail Organizer:
Qty:
Transport Bag:
Qty:
Personal Pillow:
Qty:
Lap Robe:
Qty:
Sew Much Comfort does not share any information with anyone. All your information is kept confidential.
DEVELOPED BY:
WORDSWORTH.NET
© 2008, Sew Much Comfort Inc., All rights reserved.