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

2. Patient Details

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Select patient's date of birth

3. Billing Details

4. Biocompression Requirements

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

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.

1. Leg Length - from groin to ankle:
cm
cm
2. Thigh Circumference (widest part):
cm
cm
3. Calf Circumference:
cm
cm
4. Ankle Circumference:
cm
cm
cm
cm
cm