"*" indicates required fields Step 1 of 9 11% We’re excited to get your Slingshot Socket™ ready!To help us gather the information we need, please complete the form below. If you’ve already purchased a Slingshot Socket™, select “I have a Purchase Order.” If you’re visiting the Slingshot Bionics Clinic or received this form from our care team, select “I don’t have a Purchase Order.”Purchase* I have a Purchase Order I don't have a Purchase Order Access Your ConfigurationTo help us match your Slingshot Socket™ order, please ensure that you provide the same email address and order number found in your order confirmation email (subject line: Your Slingshot Bionics order has been received).Order Number*Email Used in Your Order*This field is hidden when viewing the formConfiguration Number*This field is hidden when viewing the formWhat is the Socket Configuration in your order? Slingshot Fission™ Slingshot Fusion™ Slingshot Sling™ This field is hidden when viewing the formValidation Yes No We have found your custom configuration. Click "Next" to continue the processPlease make sure that the Email and Configuration Number are the ones found in your confirmation email. If you need more help, contact us here. Contact InformationName* First Last Email* Phone*Which Best Describes You?*Select the Option that Describes YouI am an end user (amputee or have a limb difference)I am a Prosthetist Limb InformationGender* Male Female Date of Birth* MM slash DD slash YYYY User's Gender* Male Female User's Date of Birth* MM slash DD slash YYYY Amputation Level*Select an optionBelow the KneeSymesSide of Amputation*Select an optionLeftRightBothCause of Amputation*Select an optionHealthAccident/TraumaCongenitalDo you have a prescription ready to upload?* Yes, I have it ready No, I will email one later Upload Prescription*Max. file size: 128 MB. All measurements are in centimeters (CM)Limb proximal circumferenceAt the level of the center of rotation of the knee, with liner onProximal Circumference*Please enter a number greater than or equal to 0. All measurements are in centimeters (CM)Limb distal circumference4cm above distal end, with liner onDistal Circumference*Please enter a number greater than or equal to 0. All measurements are in centimeters (CM)LengthFrom Mid Patella Tendon (MPT) to end of limbLength*Please enter a number greater than or equal to 0. General InformationYour Weight in Kilograms*Please enter a number greater than or equal to 0.Your Activity Level*Select an OptionFunction Level 1: Ability to transfer on my own.Function Level 2: Ability to walk at a single speed.Function Level 3: Ability to walk at varied speeds.Function Level 4: Ability to exceed basic ambulation.What is your limb’s condition:*Select an OptionMy limb skin is healthy.I have open sores on my limb.Additional InformationList any health and limb health considerations we should know about. Slingshot Fusion™ Fabrication AcknowledgementThe quality of the fit of the conventional socket being mailed is not critical, as much of the socket is cut away during the fabrication and assembly process, therefore it is advantageous to provide your prior socket that you no longer wear, versus your current daily-wear socket. I grant Slingshot Bionics permission to alter, cut apart, or modify the fit of my conventional socket that I will be mailing to them, in order to configure the Slingshot Fusion™ socket from it. I have the full and complete understanding that once the modifications are made, they can not be reversed. I acknowledge that should the Slingshot Fusion’s fit not work for me, I will no longer be able to try on or use the conventional socket that is being mailed to Slingshot Bionics, as it will be cut apart during the fabrication and assembly process.*The quality of the fit of the conventional socket being mailed is not critical, as much of the socket is cut away during the fabrication and assembly process, therefore it is advantageous to provide your prior socket that you no longer wear, versus your current daily-wear socket. I grant Slingshot Bionics permission to alter, cut apart, or modify the fit of my conventional socket that I will be mailing to them, in order to configure the Slingshot Fusion™ socket from it. I have the full and complete understanding that once the modifications are made, they can not be reversed. I acknowledge that should the Slingshot Fusion’s fit not work for me, I will no longer be able to try on or use the conventional socket that is being mailed to Slingshot Bionics, as it will be cut apart during the fabrication and assembly process. I have read and agree to the Slingshot Fusion™ Fabrication AcknowledgementThe Slingshot Socket™ does not come with Loctite pre-applied so that fitting adjustments can be easily made. As a final step in the fitting process, either I or those fitting the Slingshot Socket™ will Loctite each of the Screws and Truss Nuts before wearing the Device outside of the fitting area. Any Screws or Truss Nuts that DO NOT have Loctite applied and tightened correctly may back out over time and come disconnected.*The Slingshot Socket™ does not come with Loctite pre-applied so that fitting adjustments can be easily made. As a final step in the fitting process, either I or those fitting the Slingshot Socket™ will Loctite each of the Screws and Truss Nuts before wearing the Device outside of the fitting area. Any Screws or Truss Nuts that DO NOT have Loctite applied and tightened correctly may back out over time and come disconnected. I have read and agree to the Slingshot Assembly AcknowledgmentIf choosing Tele-Health Fitting, you or your designee will be directly involved in fitting and aligning the Slingshot Socket™, which will occur outside of a clinic setting, and therefore is wholly outside the direct control of Slingshot Bionics, even if Slingshot Bionics guides or directs the Tele-Health fitting of the socket. I acknowledge and understand that fitting a prosthetic socket without the direct and in-person involvement of a Prosthetist has inherent risks. I therefore assume all risk and outcomes that come about from fitting the Slingshot Socket™ by myself or my designee. I am solely responsible for ensuring that I have sufficient balance, available and sufficient assistive devices such as a walker, and in-person assistance as needed.*If choosing Tele-Health Fitting, you or your designee will be directly involved in fitting and aligning the Slingshot Socket™, which will occur outside of a clinic setting, and therefore is wholly outside the direct control of Slingshot Bionics, even if Slingshot Bionics guides or directs the Tele-Health fitting of the socket. I acknowledge and understand that fitting a prosthetic socket without the direct and in-person involvement of a Prosthetist has inherent risks. I therefore assume all risk and outcomes that come about from fitting the Slingshot Socket™ by myself or my designee. I am solely responsible for ensuring that I have sufficient balance, available and sufficient assistive devices such as a walker, and in-person assistance as needed. I have read and agree to the Tele-Health Fitting AcknowledgementWe want to ensure that you and your limb are in healthy condition, and that there are no other medical conditions that would prevent your success. As is true with any prosthesis (Slingshot Socket or conventional socket), it is best to not use it if there are existing wounds on your limb, without the direction and supervision of your medical professional team. Users with poor sensation (i.e. neuropathy) should closely monitor their limb condition, especially within the first few days of wearing any new socket. If at any time after being fit, if you experience discomfort or fitting issues, immediately contact the Slingshot Bionics Clinical Team and/or your local Doctor or Prosthetist to help diagnose what is happening before continuing use. Most socket fitting issues can be easily resolved with simple at-home socket adjustments, however discomfort can also be a result of non-socket-related issues, and therefore it is important to keep your healthcare professional team involved without delay.*We want to ensure that you and your limb are in healthy condition, and that there are no other medical conditions that would prevent your success. As is true with any prosthesis (Slingshot Socket or conventional socket), it is best to not use it if there are existing wounds on your limb, without the direction and supervision of your medical professional team. Users with poor sensation (i.e. neuropathy) should closely monitor their limb condition, especially within the first few days of wearing any new socket. If at any time after being fit, if you experience discomfort or fitting issues, immediately contact the Slingshot Bionics Clinical Team and/or your local Doctor or Prosthetist to help diagnose what is happening before continuing use. Most socket fitting issues can be easily resolved with simple at-home socket adjustments, however discomfort can also be a result of non-socket-related issues, and therefore it is important to keep your healthcare professional team involved without delay. I have read and agree to the Healthy Limb AcknowledgementSimilar to any other prosthetic socket, the Slingshot Socket™ requires a prescription for U.S. orders, since a Prosthetist can assist in fitting the socket to the user - whether via a Tele-Health video call, a Slingshot Clinic, or your local clinic. Your Primary Care Physician, Orthopedist, Neurologist, or other Local Physician can write a prescription for a “[BK or AK] socket” or “[BK or AK] prosthesis". Simply email a copy of your prescription along with your Order Number to orders@slingshotbionics.com, and we’ll prepare to ship your Slingshot Socket™ right away.*Similar to any other prosthetic socket, the Slingshot Socket™ requires a prescription for U.S. orders, since a Prosthetist can assist in fitting the socket to the user - whether via a Tele-Health video call, a Slingshot Clinic, or your local clinic. Your Primary Care Physician, Orthopedist, Neurologist, or other Local Physician can write a prescription for a “[BK or AK] socket” or “[BK or AK] prosthesis". Simply email a copy of your prescription along with your Order Number to orders@slingshotbionics.com, and we’ll prepare to ship your Slingshot Socket™ right away. I agree to email a copy of my prescription and Order Number to orders@slingshotbionics.com.The Slingshot Socket™ is designed to make the fitting process simple and not require the lengthy fabrication processes of conventional sockets. However, following the specific training steps is important to maximize the comfort outcomes. Slingshot Bionics’™ clinical services team can also join your fitting via a Tele-Health video-call to help you maximize the comfort of your Slingshot Socket™. I acknowledge that I have or will review the training videos prior to fitting the Slingshot Socket™, and that I am aware that Slingshot Bionics’™ clinical services is accessible to help if needed.*The Slingshot Socket™ is designed to make the fitting process simple and not require the lengthy fabrication processes of conventional sockets. However, following the specific training steps is important to maximize the comfort outcomes. Slingshot Bionics’™ clinical services team can also join your fitting via a Tele-Health video-call to help you maximize the comfort of your Slingshot Socket™. I acknowledge that I have or will review the training videos prior to fitting the Slingshot Socket™, and that I am aware that Slingshot Bionics’™ clinical services is accessible to help if needed. I have read and agree to the Prosthetist AcknowledgementSlingshot Fission™ Fabrication AcknowledgementThe Slingshot Socket™ does not come with Loctite pre-applied so that fitting adjustments can be easily made. As a final step in the fitting process, either I or those fitting the Slingshot Socket™ will Loctite each of the Screws and Truss Nuts before wearing the Device outside of the fitting area. Any Screws or Truss Nuts that DO NOT have Loctite applied and tightened correctly may back out over time and come disconnected.*The Slingshot Socket™ does not come with Loctite pre-applied so that fitting adjustments can be easily made. As a final step in the fitting process, either I or those fitting the Slingshot Socket™ will Loctite each of the Screws and Truss Nuts before wearing the Device outside of the fitting area. Any Screws or Truss Nuts that DO NOT have Loctite applied and tightened correctly may back out over time and come disconnected. I have read and agree to the Slingshot Assembly AcknowledgmentIf choosing Tele-Health Fitting, you or your designee will be directly involved in fitting and aligning the Slingshot Socket™, which will occur outside of a clinic setting, and therefore is wholly outside the direct control of Slingshot Bionics, even if Slingshot Bionics guides or directs the Tele-Health fitting of the socket. I acknowledge and understand that fitting a prosthetic socket without the direct and in-person involvement of a Prosthetist has inherent risks. I therefore assume all risk and outcomes that come about from fitting the Slingshot Socket™ by myself or my designee. I am solely responsible for ensuring that I have sufficient balance, available and sufficient assistive devices such as a walker, and in-person assistance as needed.*If choosing Tele-Health Fitting, you or your designee will be directly involved in fitting and aligning the Slingshot Socket™, which will occur outside of a clinic setting, and therefore is wholly outside the direct control of Slingshot Bionics, even if Slingshot Bionics guides or directs the Tele-Health fitting of the socket. I acknowledge and understand that fitting a prosthetic socket without the direct and in-person involvement of a Prosthetist has inherent risks. I therefore assume all risk and outcomes that come about from fitting the Slingshot Socket™ by myself or my designee. I am solely responsible for ensuring that I have sufficient balance, available and sufficient assistive devices such as a walker, and in-person assistance as needed. I have read and agree to the Tele-Health Fitting AcknowledgementWe want to ensure that you and your limb are in healthy condition, and that there are no other medical conditions that would prevent your success. As is true with any prosthesis (Slingshot Socket or conventional socket), it is best to not use it if there are existing wounds on your limb, without the direction and supervision of your medical professional team. Users with poor sensation (i.e. neuropathy) should closely monitor their limb condition, especially within the first few days of wearing any new socket. If at any time after being fit, if you experience discomfort or fitting issues, immediately contact the Slingshot Bionics Clinical Team and/or your local Doctor or Prosthetist to help diagnose what is happening before continuing use. Most socket fitting issues can be easily resolved with simple at-home socket adjustments, however discomfort can also be a result of non-socket-related issues, and therefore it is important to keep your healthcare professional team involved without delay.*We want to ensure that you and your limb are in healthy condition, and that there are no other medical conditions that would prevent your success. As is true with any prosthesis (Slingshot Socket or conventional socket), it is best to not use it if there are existing wounds on your limb, without the direction and supervision of your medical professional team. Users with poor sensation (i.e. neuropathy) should closely monitor their limb condition, especially within the first few days of wearing any new socket. If at any time after being fit, if you experience discomfort or fitting issues, immediately contact the Slingshot Bionics Clinical Team and/or your local Doctor or Prosthetist to help diagnose what is happening before continuing use. Most socket fitting issues can be easily resolved with simple at-home socket adjustments, however discomfort can also be a result of non-socket-related issues, and therefore it is important to keep your healthcare professional team involved without delay. I have read and agree to the Healthy Limb AcknowledgementSimilar to any other prosthetic socket, the Slingshot Socket™ requires a prescription for U.S. orders, since a Prosthetist can assist in fitting the socket to the user - whether via a Tele-Health video call, a Slingshot Clinic, or your local clinic. Your Primary Care Physician, Orthopedist, Neurologist, or other Local Physician can write a prescription for a “[BK or AK] socket” or “[BK or AK] prosthesis". Simply email a copy of your prescription along with your Order Number to orders@slingshotbionics.com, and we’ll prepare to ship your Slingshot Socket™ right away.*Similar to any other prosthetic socket, the Slingshot Socket™ requires a prescription for U.S. orders, since a Prosthetist can assist in fitting the socket to the user - whether via a Tele-Health video call, a Slingshot Clinic, or your local clinic. Your Primary Care Physician, Orthopedist, Neurologist, or other Local Physician can write a prescription for a “[BK or AK] socket” or “[BK or AK] prosthesis". Simply email a copy of your prescription along with your Order Number to orders@slingshotbionics.com, and we’ll prepare to ship your Slingshot Socket™ right away. I agree to email a copy of my prescription and Order Number to orders@slingshotbionics.com.The Slingshot Socket™ is designed to make the fitting process simple and not require the lengthy fabrication processes of conventional sockets. However, following the specific training steps is important to maximize the comfort outcomes. Slingshot Bionics’™ clinical services team can also join your fitting via a Tele-Health video-call to help you maximize the comfort of your Slingshot Socket™. I acknowledge that I have or will review the training videos prior to fitting the Slingshot Socket™, and that I am aware that Slingshot Bionics’™ clinical services is accessible to help if needed.*The Slingshot Socket™ is designed to make the fitting process simple and not require the lengthy fabrication processes of conventional sockets. However, following the specific training steps is important to maximize the comfort outcomes. Slingshot Bionics’™ clinical services team can also join your fitting via a Tele-Health video-call to help you maximize the comfort of your Slingshot Socket™. I acknowledge that I have or will review the training videos prior to fitting the Slingshot Socket™, and that I am aware that Slingshot Bionics’™ clinical services is accessible to help if needed. I have read and agree to the Prosthetist AcknowledgementSlingshot Sling™ Fabrication AcknowledgementThe quality of the fit of the conventional socket being mailed is not critical, as much of the socket is cut away during the fabrication and assembly process, therefore it is advantageous to provide your prior socket that you no longer wear, versus your current daily-wear socket. I grant Slingshot Bionics permission to alter, cut apart, or modify the fit of my conventional socket that I will be mailing to them, in order to configure the Slingshot Sling™ socket from it. I have the full and complete understanding that once the modifications are made, they can not be reversed. I acknowledge that should the Slingshot Fusion’s fit not work for me, I will no longer be able to try on or use the conventional socket that is being mailed to Slingshot Bionics, as it will be cut apart during the fabrication and assembly process.*The quality of the fit of the conventional socket being mailed is not critical, as much of the socket is cut away during the fabrication and assembly process, therefore it is advantageous to provide your prior socket that you no longer wear, versus your current daily-wear socket. I grant Slingshot Bionics permission to alter, cut apart, or modify the fit of my conventional socket that I will be mailing to them, in order to configure the Slingshot Sling™ socket from it. I have the full and complete understanding that once the modifications are made, they can not be reversed. I acknowledge that should the Slingshot Fusion’s fit not work for me, I will no longer be able to try on or use the conventional socket that is being mailed to Slingshot Bionics, as it will be cut apart during the fabrication and assembly process. I have read and agree to the Slingshot Sling™ Fabrication AcknowledgementThe Slingshot Socket™ does not come with Loctite pre-applied so that fitting adjustments can be easily made. As a final step in the fitting process, either I or those fitting the Slingshot Socket™ will Loctite each of the Screws and Truss Nuts before wearing the Device outside of the fitting area. Any Screws or Truss Nuts that DO NOT have Loctite applied and tightened correctly may back out over time and come disconnected.*The Slingshot Socket™ does not come with Loctite pre-applied so that fitting adjustments can be easily made. As a final step in the fitting process, either I or those fitting the Slingshot Socket™ will Loctite each of the Screws and Truss Nuts before wearing the Device outside of the fitting area. Any Screws or Truss Nuts that DO NOT have Loctite applied and tightened correctly may back out over time and come disconnected. I have read and agree to the Slingshot Assembly AcknowledgmentIf choosing Tele-Health Fitting, you or your designee will be directly involved in fitting and aligning the Slingshot Socket™, which will occur outside of a clinic setting, and therefore is wholly outside the direct control of Slingshot Bionics, even if Slingshot Bionics guides or directs the Tele-Health fitting of the socket. I acknowledge and understand that fitting a prosthetic socket without the direct and in-person involvement of a Prosthetist has inherent risks. I therefore assume all risk and outcomes that come about from fitting the Slingshot Socket™ by myself or my designee. I am solely responsible for ensuring that I have sufficient balance, available and sufficient assistive devices such as a walker, and in-person assistance as needed.*If choosing Tele-Health Fitting, you or your designee will be directly involved in fitting and aligning the Slingshot Socket™, which will occur outside of a clinic setting, and therefore is wholly outside the direct control of Slingshot Bionics, even if Slingshot Bionics guides or directs the Tele-Health fitting of the socket. I acknowledge and understand that fitting a prosthetic socket without the direct and in-person involvement of a Prosthetist has inherent risks. I therefore assume all risk and outcomes that come about from fitting the Slingshot Socket™ by myself or my designee. I am solely responsible for ensuring that I have sufficient balance, available and sufficient assistive devices such as a walker, and in-person assistance as needed. I have read and agree to the Tele-Health Fitting AcknowledgementWe want to ensure that you and your limb are in healthy condition, and that there are no other medical conditions that would prevent your success. As is true with any prosthesis (Slingshot Socket or conventional socket), it is best to not use it if there are existing wounds on your limb, without the direction and supervision of your medical professional team. Users with poor sensation (i.e. neuropathy) should closely monitor their limb condition, especially within the first few days of wearing any new socket. If at any time after being fit, if you experience discomfort or fitting issues, immediately contact the Slingshot Bionics Clinical Team and/or your local Doctor or Prosthetist to help diagnose what is happening before continuing use. Most socket fitting issues can be easily resolved with simple at-home socket adjustments, however discomfort can also be a result of non-socket-related issues, and therefore it is important to keep your healthcare professional team involved without delay.*We want to ensure that you and your limb are in healthy condition, and that there are no other medical conditions that would prevent your success. As is true with any prosthesis (Slingshot Socket or conventional socket), it is best to not use it if there are existing wounds on your limb, without the direction and supervision of your medical professional team. Users with poor sensation (i.e. neuropathy) should closely monitor their limb condition, especially within the first few days of wearing any new socket. If at any time after being fit, if you experience discomfort or fitting issues, immediately contact the Slingshot Bionics Clinical Team and/or your local Doctor or Prosthetist to help diagnose what is happening before continuing use. Most socket fitting issues can be easily resolved with simple at-home socket adjustments, however discomfort can also be a result of non-socket-related issues, and therefore it is important to keep your healthcare professional team involved without delay. I have read and agree to the Healthy Limb AcknowledgementSimilar to any other prosthetic socket, the Slingshot Socket™ requires a prescription for U.S. orders, since a Prosthetist can assist in fitting the socket to the user - whether via a Tele-Health video call, a Slingshot Clinic, or your local clinic. Your Primary Care Physician, Orthopedist, Neurologist, or other Local Physician can write a prescription for a “[BK or AK] socket” or “[BK or AK] prosthesis". Simply email a copy of your prescription along with your Order Number to orders@slingshotbionics.com, and we’ll prepare to ship your Slingshot Socket™ right away.*Similar to any other prosthetic socket, the Slingshot Socket™ requires a prescription for U.S. orders, since a Prosthetist can assist in fitting the socket to the user - whether via a Tele-Health video call, a Slingshot Clinic, or your local clinic. Your Primary Care Physician, Orthopedist, Neurologist, or other Local Physician can write a prescription for a “[BK or AK] socket” or “[BK or AK] prosthesis". Simply email a copy of your prescription along with your Order Number to orders@slingshotbionics.com, and we’ll prepare to ship your Slingshot Socket™ right away. I agree to email a copy of my prescription and Order Number to orders@slingshotbionics.com.The Slingshot Socket™ is designed to make the fitting process simple and not require the lengthy fabrication processes of conventional sockets. However, following the specific training steps is important to maximize the comfort outcomes. Slingshot Bionics’™ clinical services team can also join your fitting via a Tele-Health video-call to help you maximize the comfort of your Slingshot Socket™. I acknowledge that I have or will review the training videos prior to fitting the Slingshot Socket™, and that I am aware that Slingshot Bionics’™ clinical services is accessible to help if needed.*The Slingshot Socket™ is designed to make the fitting process simple and not require the lengthy fabrication processes of conventional sockets. However, following the specific training steps is important to maximize the comfort outcomes. Slingshot Bionics’™ clinical services team can also join your fitting via a Tele-Health video-call to help you maximize the comfort of your Slingshot Socket™. I acknowledge that I have or will review the training videos prior to fitting the Slingshot Socket™, and that I am aware that Slingshot Bionics’™ clinical services is accessible to help if needed. I have read and agree to the Prosthetist Acknowledgement
