Single Sample Form – Lick Sleeve

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First Name *

Last Name *

Email *

Hospital Name *

Requested Sample Size (pick 1) *

Leg Sleeve (XXS) 7-13 lbs / 3-6 kg
Leg Sleeve (XS) 13-20 lbs / 6-9 kg
Leg Sleeve (S) 20-30 lbs / 9-14 kg
Leg Sleeve (M) 30-50 lbs / 14-23 kg
Leg Sleeve (L) 50-80 lbs / 23-36 kg
Leg Sleeve (XL) 80-120 lbs / 36-54 kg
Leg Sleeve (XXL) 120-150 lbs / 54-68 kg

Recovery Suit (XXS)
Recovery Suit (XS)
Recovery Suit (S)
Recovery Suit (M)
Recovery Suit (L)
Recovery Suit (XL)
Recovery Suit (XXL)

Rear Bilateral (XXS)
Rear Bilateral (XS)
Rear Bilateral (S)
Rear Bilateral (M)
Rear Bilateral (L)
Rear Bilateral (XL)
Rear Bilateral (XXL)

Copyright: Lick Sleeve, LLC all rights reserved

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Declare withdrawal

Please fill out the following form to declare your withdrawal from the contract.