Order the Biocompression Pump

For customers or clincians

Order Form

Please fill out as many details as possible below as this expedites the process and helps us set you up with the most appropriate equipment and settings.

Your order request will be reviewed by our customer service team who will call you to confirm your booking and take your payment details.

Please note: Filling out this form does not guarantee your order until we have called you to for payment. The billing cycle for renting equipment is every 28 days.

1. Order Details

Date Requested *

Required Delivery Date *

Courier to Clinician? (fees apply) *

2. Patient Details

Patient's Name *

Patient's Date of Birth *//

Select patient's date of birth

Patient's Email *

3. Billing Details

Who is paying? *

4. Biocompression Requirements

Consult with your clinician for their recommended settings. Prescribed settings and well-fitting garments are essential to this product's success.

Treatment Pressure (20 - 80mmHg)

mmHg

5. Patient's Measurements

Provide relevant measurements of legs, trunk or arm so our staff may determine sizing.
If you require custom garments please download and complete the referral form on the Biocompression product page.

Garments required

1. Leg Length - from groin to ankle:

Left Leg Length (cm)

Right Leg Length (cm)

2. Thigh Circumference (widest part):

Left Thigh Circumference (cm)

Thigh Circumference Right (cm)

3. Calf Circumference:

Left Calf Circumference (cm)

Right Calf Circumference (cm)

4. Ankle Circumference:

Left Ankle Circumference (cm)

Right Ankle Circumference (cm)

5. Trunk circumference (widest part)

6. Affected arm circumference (widest part)

7. Chest circumference

Phone