Individual Adaptive Clothing Request
We do our best to fulfill your order as listed from available stock on hand. Substituitions may be sent.
Name (First and Last)(required):					Enlistment Date (required):
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Shorts / Pants See pictures of our clothing Show Pants adapted in which way?   Left   Right   Double   Wheel Chair   Please Limit quantity to 1 set of undergarments (4 pairs come in a set) and 2 or less items in the other rows.
Elastic waist & snap closure Small Medium Large Xlarge XXLarge XXXLarge Fits Waist Sizes: 28"- 31.5" 32"- 35.5" 36"- 39.5" 40"- 43.5" 44"- 47.5" 48"- 51.5"   Adaptation Boxers Left Boxers Right Boxers Double Women's Briefs Left Women's Briefs Right Women's Briefs Double Athletic Shorts Left Athletic Shorts Right Athletic Shorts Double Dress Shorts Left Dress Shorts Right Dress Shorts Double Lounge Pant Left Lounge Pant Right Lounge Pant Double Dress Pant Left Dress Pant Right Dress Pant Double Fixator Lounge Left Fixator Lounge Right Fixator Lounge Double Fixator Dress Left Fixator Dress Right Fixator Dress Double Swim Trunks Left Swim Trunks Right Swim Trunks Double Wheelchair Lounge Pants Quantity  Waist: Inseam: These are special order Please list your waist and inseam measurements and allow 3 wks for delivery. Wheelchair Dress Pants Quantity
Shirts See pictures of our clothing Show Shirts adapted on which side?   Left   Right   Double   Left Shoulder & Double Torso   Please Limit quantity to 2 or less per row.
Small Medium Large Xlarge XXLarge XXXLarge Fits Chest Sizes: 34"- 37.5" 38"- 41.5" 42"- 45.5" 46"- 49.5" 50"- 53.5" 54"- 56.5"   Adaptation T-shirt - Torso Left T-shirt - Torso Right T-shirt - Torso Double T-shirt * Shoulder *(Left Shoulder w/double torso)   Long Sleeve T - Torso Left Long Sleeve T - Torso Right Long Sleeve T - Torso Double Long Sleeve T * Shoulder *(Left Shoulder w/double torso)   Sweatshirt - Torso Left Sweatshirt - Torso Right Sweatshirt - Torso Double Sweatshirt * Shoulder *(Left Shoulder w/double torso)   Polo Shirt - Torso Left Polo Shirt - Torso Right Polo Shirt - Torso Double Please indicate either short or long sleeve, neck size, and sleeve length if ordering long sleeves. Dress Shirt (velcro under buttons) Quantity Short Sleeve Long Sleeve Neck Size: Sleeve Length:
Comfort Accessories Please limit yourself to one comfort item of each type.
		Quantity
Bedrail Organizer
Lap Robe
Personal Pillow w/ Case
Transport Bag
Fixator and Foot Cover
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