Hospital Adaptive Clothing Request

We do our best to fulfill your order as listed from available stock on hand. Substitutions may be sent.
Hospital Name
Attention
Shipping Address
Shipping Address 2:
Shipping Address 3:
CityStateZipcode
Phone (required):Email (required):

Shorts / Pants

Elastic waist & snap closureSmallMediumLargeXlargeXXLarge
Fits Waist Sizes:28"- 31.5"32"- 35.5"36"- 39.5"40"- 43.5"44"- 47.5"
 Adaptation
BoxersLeft
BoxersRight
BoxersDouble
Athletic ShortsLeft
Athletic ShortsRight
Athletic ShortsDouble
Lounge PantLeft
Lounge PantRight
Lounge PantDouble
Dress PantLeft
Dress PantRight
Dress PantDouble
Fixator LoungeLeft
Fixator LoungeRight
Fixator LoungeDouble
Fixator DressLeft
Fixator DressRight
Fixator DressDouble
Swim TrunksLeft
Swim TrunksRight
Swim TrunksDouble

Shirts

 SmallMediumLargeXlargeXXLarge
Fits Chest Sizes:34"- 37.5"38"- 41.5"42"- 45.5"46"- 49.5"50"- 53.5"
 Adaptation
T-shirt - TorsoLeft
T-shirt - TorsoRight
T-shirt - TorsoDouble
T-shirt *Shoulder
*(Left Shoulder w/double torso) 
Long Sleeve T - TorsoLeft
Long Sleeve T - TorsoRight
Long Sleeve T - TorsoDouble
Long Sleeve T *Shoulder
*(Left Shoulder w/double torso) 
Sweatshirt - TorsoLeft
Sweatshirt - TorsoRight
Sweatshirt - TorsoDouble
Sweatshirt *Shoulder
*(Left Shoulder w/double torso) 
Polo Shirt - TorsoLeft
Polo Shirt - TorsoRight
Polo Shirt - TorsoDouble

Comfort Accessories

Quantity
Bedrail Organizer
Lap Robe
Personal Pillow w/ Case
Transport Bag
Fixator and Foot Cover
Comments