© 2018 Cascade Dafo, Inc. All rights reserved. 27

NOTE: If you don’t choose an option, you will receive the Standard.

PosteriorHeight: c ⅔ to ¾ of leg length

Standard c Specify:

Plastic: c Polyethylene (Transfer Pattern is not an option) (Standard to 8” foot length)

c Co-poly (Transfer Pattern is not an option) (Standard above 8” foot length)

c Polypro

Inner Liner: c Softy foam Standard

(white only) c Polyethylene

c Add extra navicular padding

Straps: c Elastic removable d-ring strap Standardc Non-stretch removable d-ring strapc Non-stretch d-ring strap riveted to medial/lateral sides

c Add toe abduction strapStrapColor: c White

Standard c Other:

InstepPattern: c

No pattern Standard c Other:

Special Instructions

Thank you!

Shi

ppin

g

c Shipping info is the same as practitioner facility. –OR–

Shipping contact name:

Street address:

City: State: Zip:

c Rush order (adds $25)

Construction • Features • Options

Pat

ient

Last name:

First: c Male c Female

Date cast: / / c N    c W

Birth date: / / c Bilateral c Left only c Right only

Pra

ctit

ione

r

Name: Title:

Facility:

Street address:

City: State: Zip: Email: Phone:

Bill

ing

c Cascade P&O is billing the patient's insurance. –OR–

—UCAN No :

c Billing info is the same as practitioner facility. –OR–

c Billing facility:

Street address:

City: State: Zip:

P.O. No :

Toe Shelf—Inner LinerMedial/Lateral soft containment—Standard

DAFO 9 Softy Rev 10 (May 2018)

Adjustable night-stretching brace

Bottom StabilizationBottom covered with non-skid cover—Standard

NOTE— Unless requested otherwise, varus or valgus forefoot alignments will receive stabilization on bottom of brace to support posted (raised) region.

MEDIAL (Left) LATERAL (Left)

Hei

ght

Length

Adjustable Velcro Straps

InnerLiner

OuterFrame

Non-skid cover

Padding

Instep &Forefoot Straps

RemovableD-ringStraps

DAFO® 9

Select one

Finished Brace AnglesANKLE ALIGNMENT (Dorsiflexion–Plantarflexion)

c Correct to 3–4° DF c Correct to ° c Do not correct

HINDFOOT ALIGNMENTc Correct to vertical (if misaligned) c Do not correct

FOREFOOT ALIGNMENT NOTE: Drawings show finished orthosis.

Choose forefoot alignment. Write posting height if needed—in. or mm.

RIG

HT

RIG

HT

RIG

HT

LEFT

LEFT

LEFT

Valgus

c

Varus

c

Neutral

cNeutral

cVarus

c

Valgus

c

(Cast alignment OK)

c DFc PF

Cascade Dafo, Inc.1360 Sunset Ave, Ferndale, WA 98248ph 800-848-7332 intl +00 1 360 543 9306fax 877-856-2160 www.cascadedafo.com

TransferPattern: c No Transfer Standard (Transfers on CoPoly or Polypro outer frame only; additional cost per brace)

c Pattern: _______________________________ c Provide Own Pattern

Toe Rise and Cuff Padding Color:

c White Standard c Other: