Interactive Silicone Colour Chart - Finger - Custom Silicone

							Custom Silicone Colour Matching Chart
Finger

 Patient:                                                            Company:

 Date:                                                               Clinic Address:
 Prosthetist:

 Email:

 Telephone:

 Purchase Order Number:                                              Colorimeter Identification Number:




Y                        Pad                                                                                 Y     Finger distally

x                        y                                                                                   x     y



Y                        Finger base colour                                                                  Y     Joint

x                        y                                                                                   x     y



                                                                                                             Y     Dorsal

                                                                                                             x     y



                                                                                                             Y     Joint

                                                                                                             x     y



                                                                                                             Y     Trim

                                                                                                             x     y




                Nail detail                                                            Nail shape (please tick)

    Silicone            Acrylic



                                              Nail length (please specify)                                        See photo for details



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                                                                                                                                          L26020