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Our referral forms can help get your client back to work.

For custom heated gloves

Right-click to download the referral form for custom heated glove liners

This form includes a page for the client’s hand to be traced, and record the key dimensions which will allow us to create a customized fit. You can fill out the first page on a laptop or desktop computer, then print it out and trace the hand on the back. The completed form can be faxed back to us at 604-271-2606, or scanned and emailed back to us. It is important to note all dimensions as required, as the image of the traced hand may shrink or become skewed on the fax or scan.

For custom heated garments

Right-click to download the referral form for custom heated socks, wraps, and other garments

This form includes a page for the details and dimensions for the sock, wrap, liner, or other garment. You can fill out this PDF form on a laptop or desktop computer, save, and print it out and fax it to us, or submit directly via email. If preferred, we can connect with your client directly to get this information.

For custom prosthetic heating devices

Right-click to download the referral form for custom prosthetic heating devices

This form includes a page for the details of the prosthetic device itself, and how best to incorporate the heating device into the unit. Depending on the client’s needs or cold intolerance issues, we may have additional questions for the prosthetist or the client. You can fill out the PDF form on a laptop or desktop computer, save, and print it out and fax it to us, or submit it directly via email.

You can also download our brochures here:

Cold Intolerance Brochure

Get the Chill Out of Your Prosthetics

 

 

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