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  • Access Legacy PDF work order. Legacy form will be accepted until Aug 15th. 

  • Legacy form will no longer be accepted. 

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  • Please do not print the Review page.

    Scroll to the bottom, hit Complete and then download the work order. 

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    Intake Information

  • Please enter a correct Fab PCC#

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  • Daily HFN Capacity

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    Patient Information
    • Patient Information: 

    • Submission Type:

      • Plaster Cast: Negative or Positive

        Please include a printed Work Order with the cast when shipping.

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    Configurator
  • 0/250
    • Measurements: 
    • Image-347
    • Image-972

    • *Weight Bearing Foot Tracing or Foot Impression Required.

    • Download CROW Weight Bearing Foot Tracing Sheet. Include the filled out sheet with the Work Order print out when shipping Cast. 

       .CROW Weight Bearing Tracing Sheet

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    • Alignment: 

    • Please provide cast in finished device alignment. Corrections are limited to +/- 5° in the sagittal plane.

    • Final Ankle Position:

    • Set the Ankle in   *   ° of      *        

    • Corrections are limited to +/- 5° in the sagittal plane.

    • Modifications: 
    • Image-950
    • Materials/Design: 

    • Plastic/Padding

    • i

      Finished Plastic Thickness will be within 10% of the requested thickness. 

    • Special Order Transfer Papers can increase device turnaround time.

    • PLEASE SELECT DIFFERENT OPTIONS FOR TRANSFER PAPERS.

    • Finishing: 

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    Notes
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