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The following forms and tape kits are for the measuring and ordering of Gottfried brand compression therapy supports and garments. They are intended for use by qualified professionals only.
Links to forms and tape kits are below. Visit our
Website to download them.Qualified professionals may request copies be sent. PDFs require
Adobe Reader.
Re-visit this page for access information.
• Forms Only (for use with Paper Tapes) 
1
These forms may be printed directly form the Website, downloaded as PDFs, or you may request copies be sent to you. They are intended for use with paper tapes, which can be returned with the completed order form.
Form No. 11 (Old Form No. A-13-AY3)
For ordering chest, waist, thigh and knee length vascular & lymphatic supports & burn garments. Back: Instructions on how to measure with paper tapes.
Also included in Tape Kits - B & C.
Form No. 14 (Old Form No. A-13-SY)
For ordering stump vascular & lymphatic supports & burn garments. Back: blank.
Also included in Tape Kits - B & C.
Form No. 18
For ordering foot glove vascular & lymphatic supports & burn garments. Form No. 19 also required. Back: blank.
Form No. 19
Foot Tracing to accompany Form No. 18. Back: blank.
Form No. 21 (Old Form No. A-12A-W3)
For ordering arm sleeve and gauntlet vascular & lymphatic supports & burn garments. Back: blank.
Also included in Tape Kit A.
Form No. 31 (Old Form No. B-1-W)
For ordering glove and gauntlet vascular & lymphatic supports & burn garments. Back: blank.
Also included in Tape Kit - D.
Form No. 32 (Old Form No. B-1A-W)
Accompanies Form No 31. A scaled tracing of hand for optimal fit. Back: blank.
Also included in Tape Kit - D.
Form No. 33 (Old Form No. B-2-W)
For ordering face mask & chin strap vascular & lymphatic supports & burn garments. Back: blank.
Form No. 34 (Old Form No. B-3-W)
For ordering body suit, brief & bolero vascular & lymphatic supports & burn garments. Back: blank.
• IMF Forms Only (for use without Paper Tapes)
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These forms may be printed directly form the Website, downloaded as PDFs, or you may request copies be sent to you. They are intended for use with standard measuring tapes. Dimensions can be provided in either inches or metric.
Form No. 12 (Old Form No. A-11-W)
For ordering body anklet, thigh, knee length, and AK or BK stump vascular & lymphatic supports & burn garments. Back: Instructions on how to measure without using paper tapes.
Form No. 13 (Old Form No. A-13-Y)
For ordering waist length and panty girdle vascular & lymphatic supports & burn garments. Back: blank.
Form No. 22 (Old Form No. A-12-W)
For ordering arm sleeve and gauntlet vascular & lymphatic supports & burn garments. Back: blank.
• Tape Kits & Prescription Blanks 1
Tape kits and Prescription blanks must be requested (download not available). Tape kits include forms, applicable one-use paper tapes, prescription blank and pre-addressed return envelope. Prescription blanks may be requested separately.
(A) Tape Kit - Upper Extremity
Contains one each of: Form No 10 Prescription Blank, Order Form 21, AT-1 Paper Tape, Pre-addressed Return Envelope.
(B) Tape Kit - Chest, Waist, Knee & Stump
Contains one each of: Form No 10 Prescription Blank, Order Form 11, Pre-addressed Return Envelope and two each of: LT-2 Paper Tape.
(C) Tape Kit - Knee
Contains one each of: Form No 10 Prescription Blank, Order Form 11, Pre-addressed Return Envelope and two each of: KT-1 Paper Tape.
(D) Tape Kit - Glove & Gauntlet
Contains one each of: Form No 10 Prescription Blank, Pre-addressed Return Envelope and two each of: Order Form 31 and FT-1 Paper Tape.
Form No. 10 (Old Form No. R-11W3)
Prescription Blank. All Gottfried Medical Brand vascular & lymphatic supports & burn garments are classified as medical devices and require a prescription when ordered.
The Dealer Kit
These kits are available to authorized dealers of Gottfried Brand products. They contain all of the brochures intended for the professional audience, as well as order forms, tape kits and (when applicable) a price list. Kits are automatically provided to new dealers.
Request a Kit (Current Dealers only) |
Become a Dealer
Learn More about Gottfried Medical’s Dealer Order Forms & Tape Kits
Do you have a general question about our forms and tape kits? Anyone may
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product experts via our Blog.
