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

Madrid Facemask to Scarborough, Canada / Volleyball - Soccer

Published on Jun 22, 2016

6/21/16
Arden T./Scarborough, Ontario Canada
Injury: Broken Nose
Sport: Volleyball
Model: Madrid
http://indianabrace.com/basketballfac...

Hoosier OTS Broken Nose Guard to Cairo, Egypt

New Order (#3789) Hoosier Face Mask

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www.indianabrace.com	9:23 AM (22 hours ago)

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Order Confirmation

Thank you for your order, Amr Bxxxxxxx. Your order number is: 3789 Date of order: 5/19/2013 9:23 AM Shipping Method: USPS Priority Mail International Payment Method: Credit card payment
Ship To Amr Baxxxxxx XX Mostafa Refeat Street, Sheraton Heliopolis Area Cairo, 123450 Egypt Phone:0106XXXXX02
Additional Information Diagnosis: broken nose
Product Information
Product Name Part No. Quantity Item Price Total Price CLYDE'S HOOSIER MASKS - NO VISION OBSTRUCTION - EASY TO USE - WORLDWIDE SHIPPING Select A Model: OTS - Broken Nose Only What is the injury?: Broken Nose Only Measurement A: Inside ear to ear across tip of nose.: 29 cm Measurement B: Top of forehead to tip of nose.: 9 cm Height?: 172 cm Weight?: 68 Kg Sex?: Male Sport?: Soccer I ackknowledge and agree to the terms and conditions of Indiana Brace's Sales and Refund Policy.: Yes L2999 1 $229.00 $229.00 Subtotal: $229.00 Shipping: $36.75 Tax: $0.00 Order Total: $265.75