Custom Fabrication Order Forms
Order Forms for Custom Products
For your convenience, all WillowWood custom product order forms are listed below. Scroll down to find your desired order form.
Alpha DESIGN® Online Forms Now Available!
> Click here for help on how to start your DESIGN order!
Complete and submit the online order form(s). Upon submission, an order summary will be emailed to the address you provided. Print the summary and include a copy with the cast of the residual limb.
If providing a shape file, you may attach file(s) to the online order form. Missing information may delay your order. Please fill out the form completely and accurately. For bilateral amputees, please complete separate forms for each residual limb.
Alpha DESIGN AK Liner Order Form
Alpha DESIGN Liner BK Order Form
Alpha DESIGN Liner Duplicate Order Form
Alpha DESIGN AK Liner Order Form – printable version
Alpha DESIGN BK Liner Order Form – printable version
Test Socket Order Form
Save the order form to your computer, complete the form and then print it to order a transtibial or a transfemoral test socket. Be sure to include the form with the plaster cast. If sending a shape file from OMEGA® please fax the form to 888.878.4858 . Please be sure to complete all information on the form.
To order a standard transtibial or transfemoral socket with LimbLogic, locking, or suction suspension, save the Definitive Socket Order Form to your computer, complete, and print the order form. Fax to 800.878.4858 or e-mail to firstname.lastname@example.org. Be sure to complete all information on the form. Form includes AK by Measurement information. View available transfemoral brim shapes.
To order a RevoFit Socket, save the RevoFit Definitive Socket Order Form to your computer, complete, and print. Include the form with your diagnostic socket or e-mail to email@example.com.
WillowWood One TF System with LimbLogic® Definitive Socket Order Form
WillowWood One TF System – Suction Definitive Socket Order Form
After determining the alignment, send the diagnostic socket for the WillowWood One TF system to WillowWood for fabrication of the removable brim and definitive socket. Save the writable order form PDF for the selected suspension method (LimbLogic or suction) to your computer, complete the form, and print. Include the completed order form with the diagnostic socket. Please be sure to complete all information on the form.
WillowWood One TT System Definitive Socket Order Form
If opting for WillowWood to fabricate the definitive socket, send the diagnostic socket for the WillowWood One TT system to WillowWood. Save the writable order form PDF to your computer, complete the form, and print. Include the printed order form with the diagnostic socket.
If selecting elevated vacuum, please place the serial number label, found in the LimbLogic box, on the form. Be sure to complete all information on the form as an incomplete form could delay the order.