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Patient's measurements / Medidas del paciente
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* Indicates required question
Today's date / Fecha de hoy
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MM
/
DD
/
YYYY
Patient's name / Nombre del paciente
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Your answer
Patient's last name / Apellido del paciente
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Your answer
Date of birth / Fecha de Nacimiento
*
MM
/
DD
/
YYYY
Measurements / Medidas
My measurements are in / Las medidas son en
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Centimeters/ Centrímetros
Inches / Pulgadas
1. Contour at level of the nipples /Contorno al nivel de los pezones
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Your answer
2. Length from the nipple to the fold of the leg / (hip joint) - Distancia entre el pezón y el pliegue de la pierna (articulación de la cadera)
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Your answer
3. Contour at the umbilical level / Contorno al nivel del ombligo
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Your answer
4. Contour at the hip level / Contorno al nivel de la cadera
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Your answer
5. Contour of the right thigh / Contorno del muslo derecho
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Your answer
5. Contour of the left thigh / Contorno del muslo izquierdo
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Your answer
6. Distance from the fold of the leg (hip joint) to the knee / Distancia entre la cadera y la rodilla
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Your answer
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