Info Sheet - Townsend Design

Premier SeriesLigament BracingRoutinely Prescribed For...Patients who have experienced ligament injuriesand/or reconstructive knee surgery.Braces Can Be Ordered...• Custom from a cast, digital leg scan, CAS measurementdevice or new Custom Configuration System (photos)Offered With These Standard Features...• Custom Molded Solid Core Carbon Graphite Shells• Patented Townsend Motion TM5+ Hinges• Extension Stop Kit• Patented Synergistic Suspension Strap• Anti-Migration Strap Padding• Rotation Control Tibial Shell Contour• High Gloss Paint Or Powdercoat FinishAvailable Options Include...• ACL Or Combined Instabilities• 13, 14, 15 And 16 Inch Shell Length• Hinge Material -- Aluminum, Titanium Or Stainless• Compression/Suspension Anti-Migration Package• Flexion Stop Kit• A Variety Of ColorsTownsend’s most popular customligament knee brace, the Premierfeatures a lightweight, low profiledesign that achieves excellentcontrol and patient compliance.Optional Shell ConfigurationsThe Premier is available in a variety of custom shell configurations.Optionalposteriortibia shell.Optional doubleband tibia providesadditional supportand functional control.Optional singleupright KAFOwith leg extensionand heel cup forrotary controlor to eliminateany potential forbrace migration.www.townsenddesign.com Corporate Headquarters For Thuasne North America 800.432.3466

General InformationPatient’s Last Name:Patient’s First Name:Male Female Age Height WeightWork/Activities: Activities of Daily LivingNon-Contact Sports Contact SportsLeg: Left RightLigament: ACL PCL LCL MCLMeniscus Damage: Medial LateralSurgeries (type/date):Prescribing Physician:If there is a question about this order, who should we contact?Name:Phone:Email:BILLING: P.O. Number:Townsend Account Number:Bill To:Address:City:State: Zip Code: Country:Phone:Fax:Ship To:Address:City:State: Zip Code: Country:Phone:Attention:Fit Date: If known, please indicate the date you arescheduled to fit the patient:Shipping Preference:Ground 2-Day P.M. 2-Day A.M.Next Day P.M.Next Day A.M.(If no preference is indicated, this order will be shipped 2 Day P.M.)Note: We do not ship new or repaired products directly to patients.Premier Ligament Knee BracesCasts: 18-20 inch length; full extension; non-weight bearing, footdorsiflexed; quad relaxed; landmarks indicated; cut off back of the leg.Model*Indicates additional charges applyACLCombined Instabilities (choose strap or band)PCL Strap* PCL Rigid Band*Thigh Shell Length 7 Inch 8 InchTibia Shell Length 6 Inch 7 Inch 8 InchTibiaC: Anterior Single BandD: Posterior Single BandE: Double Band* (7” or 8”)C D ESingle Strut KAFO (Must Complete Additional Form For Brace Extension)TM5+ Hinges -- Includes extension stop kitOptional Flexion Stop Kit*Add optional extension assist bands/posts*TM5+ Hinge Material6061 Aluminum Stainless Steel*Finish and ColorPowdercoat FinishBlack Antique PewterRoyal Blue BurgundyHigh Gloss Paint FinishBlack Royal Blue Burnt OrangeDark Violet Emerald Green Steel BlueQuicksilver Indy Yellow BurgundyWhite BeigeCustom Paint Finish* -- Indicate Custom Paint #______OptionsC/S Package*Compliance/Suspension semi rigid padded inserts added to thigh shellto increase dynamic compression and enhance suspension.No wraparound attachment ofSynergistic Suspension Strap(recommended if patient has a prominent fibular head)Spooner Patella Stabilizing Attachment*Brace Cover*Posterior Closure: Black BluePull OnUndersleeves*18” Cotton 18” Neoprene 22” NeopreneThigh Sleeves*1/8 Atrophy Thigh Sleeve 1/16 Comfort Thigh SleeveTOWNSEND’S SHIPPING DEPARTMENT USE ONLYNEW BRACE SERVICE -- Original Brace Returned? Yes NoRECEIVED _____________ SHIPPED VIA ______________Townsend Design4615 Shepard St., Bakersfield, CA, 93313Phone: 800.432.3466 or 661.837.1795; Fax: 800.798.2722Special Instructions: _______________________________________________________________________________________________________________________