Calgary Lymphedema Rehabilitation and Consulting Services Inc.
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Providing premiere Lymphedema management through evidence-based practice

 

  


Products Order Form

If you are interested in ordering or getting fitted for a new compression garment, simply complete the following.  If you would like to replace your bandaging materials, please outline your needs in the “questions or comments” section.  We will contact you to provide a price quote, confirm your order, and answer your questions! 

Full Name: *
Daytime Contact Number: *
Evening Contact Number:
Email Address: *
Full Mailing Address:
Family or Referring Physician:
Have you been seen in our program? Yes       No
Would you like an exact re-order of your
current compression garment? 		Yes       No
Would you like your order mailed directly to you? Yes       No
Requests, questions or comments: 
            (* indicates a mandatory field)