10/18/18 Madrid Mask #6965 to Laurie in Medway, MA

DATE: 10/18/18

CUSTOMER: Laurie G.'s Daughter

INJURY: Broken Nose

RX: Clyde's Hoosier face Mask - Madrid Soccer Model

LINK: http://indianabrace.com/basketballfacemask.aspx

SPORT: Soccer

HISTORY: 5'2" Female 115lbs

CONTACT: Clyde or Text Direct 317-445-1475

E-MAIL: clyde.peach@gmail.com

WEBSITE: www.indianabrace.com

Clyde's Hoosier Madrid Soccer Mask - Broken Nose

10/12/18 CLIENT: Tresa R./Royal Palm Beach, FL INJURY: Broken Nose RX: Clyde's Madrid soccer mask for broken nose LINK: http://indianabrace.com/basketballfac... SPORT: Soccer SPECS: 5'1" 104 lbs. Female CALL/TEXT: Clyde Direct 317-445-1475 EMAIL: clyde.peach@indianabrace.com www.indianabrace.com

Broken Nose Mask - Clyde’s Hoosier Face Mask #6798

5/1/18
CLIENT: Brock E./Greenwood, IN
INJURY: Broken Nose
RX: Clyde's Madrid Soccer Mask Black LDP
http://indianabrace.com/basketballfacemask.aspx
SPORT: Soccer
HISTORY: 6'1" Male 175
Call or Text Clyde 317.445.1475
www.indianabrace.com

Broken Nose - Madrid Mask #6692 to Michael/Tomball, TX

2/2/18
PA: Michael O.'s son/Tomball, TX
DIAGNOSIS: Broken Nose
RX: Clyde's Madrid Soccer Mask
http://indianabrace.com/basketballfacemask.aspx
HISTORY: Male, 4'9". 90lbs
PLAN: Fabricate Madrid soccer mask LDP Black for broken nose.
www.indianabrace.com
Call Clyde 800.253.6217 TXT: 317-445-1475

Broken Nose Mask #6666 / Soccer / Marc T. - Omaha, NE

1/13/18
PA: Marc T.'s daughter / Omaha, NE
Diagnosis: Broken Nose
RX: Clyde's Custom Madrid Soccer Mask
http://indianabrace.com/basketballfacemask.aspx
History: Teenage female 5'3" 110 lbs /sustained nose injury during soccer match.
PLAN: Fabricate a Madrid style soccer mask made from DuPont Surlyn.
www.indianabrace.com
Call Clyde 800-253-6217

Broken Nose: 9/8/17 Madrid Mask #6518 to New Mexico Highlands Soccer

http://indianabrace.com/basketballfacemask.aspx

Call Clyde 800.253.6217

Broken Nose: 9/7/17 Madrid Mask / Soccer - TO: Michael in Tahlequah, OK

http://indianabrace.com/basketballfacemask.aspx

Call Clyde 800.253.6217

8/31/17 Broken Nose: Hoosier Mask #6508 Madrid Model/Soccer to Oliver/Toronto, Canada

http://indianabrace.com/basketballfacemask.aspx

Broken Nose: Hoosier Mask #6488 Madrid Soccer Model to Jeff in Mount Ste...

Broken Nose: Hoosier Mask #6486/ Madrd model to Brett in L.A./Soccer

Broken Nose Mask: Hoosier Madrid Model Soccer Mask #6401 to Marne in Wes...

Madrd Mask #6401 to Marne / West Haven, UT

Website Order Taken : 6/05/17 @ 12:51PM Shipped: 5/29/17 @ 5:00 PM
Carrier: FedEx 2nd Day Air
PA: Marne W's (son)/West Haven, UT
RX: Protective Mask for Broken Nose - Madrid Model
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXB
HX: Athlete has sustained nasal fracture during a recent soccer match.
Plan: Custom-fabricate Madrid model (color: black) #6401
using shatter proof LDP that will not re-injure recent
fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Low profile design to allow for headers both side and front. Add gentle moleskin felt contact bumper pads internally for
comfort.
SKU: madrid#6401
Country of Origin: Made in USA / Indianapolis, IN by Clyde Peach, CO
Sport: soccer

ABC Certified

User Comments: male 5'3 1/2" 110 lbs
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475 Email: clyde.peach@gmail.com
American Board for Certification in Orthotics and Prosthetics

Broken Nose Mask: Madrid Soccer Mask to James in Massapequa, NY 5/28/17

Website STAT Order Taken : 5/28/17 @ 2:55 PM Shipped: 5/29/17 @ 5:00 PM UPS 2nd Day Air
PA: James M.'s (son)/Massapequa, NY
RX: Protective Mask for Broken Nose - Madrid Soccer Model
DX: Fractures of Nasal Bones

James's Madrid Soccer Mask / Son's Broken Nose

ICD-10-CM Diagnosis Code: S02 2XXB
HX: Athlete has sustained nasal fracture during a soccer match.
Plan: Custom-fabricate Madrid model (color: black) using shatter proof LDP that will not re-injure recent fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Low profile design to allow for headers both side and front. Add gentle moleskin felt contact bumper pads internally for comfort.
Country of Origin: Made in USA / Indianapolis, IN
Sport: soccer
User Comments: male 5'8 1/2" 152 lbs / This is for my son. Please call me if the STAT order and this shipping will not get to me by Friday 6/2/17 -big match.Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475
Email: clyde.peach@indianabrace.com
American Board for Certification in Orthotics and Prosthetics

Broken Nose: Madrid Soccer Mask to Christen in Brighton, CO - 5/23/17

Website Order Taken : 5/19/17 @ 10:13 PM PM Shipped: 5/22/17 @ 5:00 PM UPS 2nd Day Air
PA: Christen D.(daughter)/Brighton
RX: Protective Mask for Broken Nose / Madrid soccer model
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXB
HX: Athlete has sustained nasal fracture during a soccer match.
Plan: Custom-fabricate Madrid model face mask (color: black) using shatter proof LDP that will not re-injure recent fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Low profile

Christen's Daughters Madrid Soccer Mask

design to allow for headers both side and front. Add gentle moleskin felt contact bumper pads internally for comfort.
Country of Origin: Made in USA / Indianapolis, IN
Sport: soccer
User Comments: female 5'6" 140 lbs / This is for my daughter. She is a goalie on her soccer team. Going to Regionals in June!
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call Clyde 800.253.6217 Text: 317.445.1475 Email: clyde.peach@gmail.com
American Board for Certification in Orthotics and Prosthetics

Broken Nose: Madrid Mask #6358 to William in Mechanicsville, VA

Website Order Taken : 5/09/17 @ 10:13 PM PM Shipped: 5/11/17 @ 5:00 PM UPS Ground
PA: WilliamA.(daughter)/Mechanicsville, VA
RX: Protective Mask for Broken Nose - Madrid Model
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXB
HX: Athlete has sustained nasal fracture during a soccer.

William's Daughters Madrid Soccer Mask

Plan: Custom-fabricate Madrid model (color: black) using shatter proof LDP that will not re-injure recent fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Low profile design to allow for headers both side and front. Add gentle moleskin felt contact bumper pads internally for comfort.
Sport: soccer
User Comments: female 5'5" 120 lbs
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475 Email: clyde.peach@gmail.com
American Board for Certification in Orthotics & Prosthetics

Broken Nose Mask / Madrid LDP Black Soccer Mask to Anders in Roskilde, D...

Published on Apr 21, 2017
Website Order Taken : 4/18/17 @ 8:13 PM PM Shipped: 4/21/17 @ 5:00 PM USPS International Priority Mail
PA: Anders J./Roskilde, Denmark
RX: Protective Mask for Broken Nose
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXB
HX: Athlete has sustained nasal fracture during a soccer.
Plan: Custom-fabricate Madrid model (color: black) using shatter proof LDP that will not re-injure recent fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Low profile design to allow for headers both side and front. Add gentle moleskin felt contact bumper pads internally for comfort.
Sport: soccer
User Comments: None
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475 Email: clyde.peach@gmail.com

Ander's Madrid Mask

American Board for Certification in Orthotics & Prosthetics

Broken Nose Mask / Madrid LDP Soccer Mask to Tigres UANL Monterrey, Mexico

Published on Apr 21, 2017
Website Order Taken : 4/20/17 @ 8:13 PM PM Shipped: 4/21/17 @ 5:00 PM FedEx Next Day
PA: Tigres UANL Soccer/Monterrey, Mexico
RX: Protective Mask for Broken Nose
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXB
HX: Athlete has sustained nasal fracture during a soccer match.
Plan: Custom-fabricate Madrid model (color: black) using shatter proof LDP that will not re-injure recent fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Low profile design to allow for headers both side and front. Add gentle moleskin felt contact bumper pads internally for comfort.
Sport: professional soccer
User Comments: We need this ASAP as we are playing an important match this Saturday.
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475 Email: clyde.peach@gmail.com
American Board for Certification in Orthotics & Prosthetics

Broken Nose Mask / Madrid Model Soccer Mask to James in Brandon, MS

Published on Apr 17, 2017

Website Order Taken : 4/14/17 @ 12:51 PM Shipped: 4/17/17 @ 5:00 PM UPS 2nd Day Air
PA: James R. (son) /Brandon, MS
RX:  Madrid Model Protective Mask for Broken Nose
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXB
HX: Athlete has sustained nasal fracture during a recent soccer match.
Plan: Custom-fabricate Madrid model (color: black) using shatter proof LDP that will not re-injure recent fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Low profile design to allow for headers both side and front. Add gentle moleskin felt contact bumper pads internally for impact comfort.
Sport: soccer
User Comments: Male / 5'7" / 140 lbs. /
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475 Email: clyde.peach@gmail.com

James's Actual Madrid Mask

American Board for Certification in Orthotics & Prosthetics

Broken Nose Mask / Madrid Model Soccer to Brent D. / Winnetka, IL STAT

Website Order Taken : 3/20/17 @ 7:56 PM Shipped: 3/21/17 @ 5:00 PM UPS Next Day Air
PA: Brent D's  (daughter) /Winnetka, IL
RX: Protective Mask for Broken Nose
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXA
HX: Athlete has sustained nasal fracture during soccer.
Plan: Custom-fabricate Madrid model (color: clear) using shatter proof DuPont Surlyn that will not re-injure recent fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Add gentle moleskin contact bumper pads internally for comfort.
Sport: soccer
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475 Email: clyde.peach@gmail.com
American Board for Certification in Orthotics & Prosthetics

Broken Nose Mask / Clyde's Famous Face Masks

3/2/17
Website Order Taken : 2/28/17 @ 8:12 PM Shipped: 3/2/17 @ 5:00 PM USPS Priority Mail
PA: Jennifer I. (son) / Woods Cross, UT
RX: Protective Mask for Broken Noses
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXA
HX: Athlete has sustained nasal fracture during a various.
Plan: Custom-fabricate Hoosier model (color: clear) using shatter proof DuPont Surlyn that will not re-injure recent fractures, will shape to face naturally and avoid eye injuries. Customize design for maximum nasal protection and minimum obstruction of peripheral and downward vision. Add gentle contact bumper pads internally.
Sport: Soccer
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475 Email: clyde.peach@indianabrace.com
American Board for Certification in Orthotics & Prosthetics
Comment:Clyde, thank you for talking with me this morning and helping me make a decision for my son.

Clyde's Face Masks / Call Clyde 800.253.6217 or Text 317.445-1475

2/21/17
PA: Morgan H./Rutherfordton, NC
RX: Mask for Broken Nose / Soccer
DX: Nasal Fracture ICD-10 Billing Code S02.2xxB
P: Fabricate Madrid mask for soccer / female / 5'6" / 140lbs / color:black
Website: www.indianabrace.com
Practitioner: Clyde Peach CO - ABC Certified Orthotist #1321
American Board for Certification in Orthotics & Prosthetics