Custom Neoprene Orthotics

Hand Splint Order Form

The Hand Splint Order Form may be used to order a custom wrist or hand product or any of Benik's adult or pediatric stock wrist and hand supports.

Click on the link below to view and download our Hand Splint Order Form.

Hand Splint Order Form (PDF)

Our Hand Splint Order Form now has the capability to be filled out on your computer, which will also allow you to email the completed form to us. To take advantage of this option, it is recommended you have the most recent version of the free Adobe Acrobat Reader.

If you are unable to view the form or some functions of the form do not seem to be working properly, you likely need to update your version of Adobe Acrobat Reader. Easily download or update the free Adobe Acrobat Reader here.

Please be careful to include all necessary information to ensure your order is completed accurately and quickly. See our Hand Splint Sizing Guide for additional measuring details.

Fax your completed order form to 1-360-692-5600 or e-mail to

Call 1-800-442-8910 for assistance.