Body Measurement Chart Custom Made Pressure Garments
All Fields are mandatory and All measurements in Centimeters

FACE


Circum
of nose
bridge
10
Throat
to stemal
notch
9
Circum
of
neck
8		 Around
Head at
chin angle
7		 Circum
above
eyebrow
6		 Chin to
mouth
5 		Chin to
Eyes
4 		Width of
mouth
3 		Length of
Ear
2 		Within of
Ear
1
Pressure Garments
Face Mask
- - -
-
-
Chin Strap
-
-
-
-
-
-
-
-
Chin-Extension Collar

Please fill in information bellow
Field Marked with * is mandatory

Name :
*
Address :


Country:
*
Pincode :
*

Tel. with Country code + area code:
 
*

Fax  with Country code + area code:

Mobile :


Sex :
*
Age :
*

Date :


Product :


 
Measured by :


Specialty :

 
Doctors Name :
*
Doctor's Tel. :
Country Code + City Code  
*

Doctor's Email :

Other Details :


Email :
*