How to Order

How to Order

Ordering a Legsim is easy.

Print the form below. All required data is entered into the upper box; diagrams and other notations are utilized only by Hartford Walking Systems. Measurements must be included -- completed by a physical therapist or prosthetist.

Fax the completed form to 315-735-1659 or fill out the form below (payment information must still be faxed).

Based on these specifications, HWS will work directly with the patient's health care professional to build a customized system. The details are very straightforward, colorfully illustrated, and the process takes approximately fifteen minutes.

If you have any questions or special needs, please phone 315-735-1659 between 9:00 AM - 5:00 PM (EST) or email us at our new address: schrader@hartfordwalkingsystems.com.

For more information, as well as pricing and payment options, visit our FAQs page.

Name

Date

Phone

Email

Address

City

State

Zip Code

Age

Sex

Weight

Waist

Hips

Height

Shoe Size



Type of Injury:  BK AK Hip Disartic

Missing or Injured Leg:  L R

Crotch to floor with shoe on (inches)

Inseam (inches)

Able to stand on one leg:  Yes No

Do you wear prosthesis?:  Yes No

If yes, hours per day


Prosthetist / PT / Recognized Caregiver

Company

Phone

Fax

Address

City

State

Zip Code



Disclaimer: We do not give, share, sell or transfer any personal information provided to any third party.