3D PRINTED AFO

Form Title
Legacy form will be accepted until Sep 1st. Access Legacy PDF work orders below:

3D Printed Solid, Semi-Solid, PLS & Articulated AFO MCS 3D AFO
Please do not print the Review page.

Scroll to the bottom, hit Submit and then download the work order.
!!!New!!! You can now Save your progress. Check the FAQ for more info.
3D PRINTED AFO

Intake Information
Patient ID:*

First InitialLast Name
PO or Encounter #:*
Clinician Name:*
Fabrication Location:*
Clinician Email:*
Please enter to receive confirmation.
Clinician Phone Number:*
Please enter a valid phone number.
Requested In-Office Date:

MonthDayYear
Date
Daily HFN Capacity
Return Shipping Method:

Ground2-dayPriority OvernightFirst OvernightLocal CourierPick up
Return Shipping Method:*
Return Shipping Method:*
Shipping is same as Billing Address:*

YesNo
Bill to PCC#:*
Ship to PCC#:*
Ship to Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bill to Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Today's Date:*

MonthDayYear
Date

3D PRINTED AFO - {deviceType1068}
Notes
Your order will be sent to CDC after submission along with the Scan. No futher action is needed.

(No Entry required at the LEO portal)
Scan Upload:*

Accepted File types: med, fsn, op3, stl - 60 MB File Size Limit
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Average Cast Thickness - Left (mm): *
Decimal Value Optional
Average Cast Thickness - Right (mm): *
Decimal Value Optional
Outside Cast Forefoot ML - Left (mm):*
Decimal Value Optional
Outside Cast Forefoot ML - Right (mm):*
Decimal Value Optional
Outside Cast Ankle ML - Left (mm):*
Decimal Value Optional
Outside Cast Ankle ML - Right (mm):*
Decimal Value Optional
Non-standard designs (custom trimlines, aesthetic additions, etc.) cannot be accommodated with this order form. If a device with these changes are needed, please reach out directly to 3DPrinting@Hanger.com
Technical Consult: I would like a call to discuss prior to starting fabrication.

Yes
Who would you like a call from?*

Modifications (Modifier)Design options on device (Fab Supervisor)Shipping/Billing (Customer Support)
Technical Consult Team:
Notes:

0/250
Image upload (Optional):

Allowed Image types: jpg, jpeg, png, gif
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Bilateral
-F0036
-F2600
-F0051
-F2840
-F2820
-F2820
-F2820
-F2820
-F2820
-F2820
-F1915
-F9036
-F0046
-F0040
-F0040
-F0028
-F0052
-F1101
-F3310
-F0046
-F0046
- F0047
-F0053
Raven Component Codes:
Composite Strut:
Joints:
Posterior Stop:
Should be Empty:

Intrinsic Heel Skive requires external posting/wedging.