See The Trainer, Sports Medicine Stores

NAME: DATE:

DOCTOR NAME:

SUBSTITUTION PERMITTED

DISPENSE AS WRITTEN

Sports Supports · Back Care Products · Foot Orthotics · Knee Braces
Educational Materials · Athletic Training Supplies

13106 W. Dodge Rd. Omaha, NE 68154 (402)493-4747 (402)493-4774 Fax

2711 S. 48th St. Lincoln, NE 68506 (402)484-5665 (402)484-5827 Fax

4102 Twin Creek Dr. #118 Bellevue, NE 68123 (402)502-9782 (402)502-9791 Fax

1250 NW 128th St. Suite 160 Clive, IA 50325 (515)274-0055 (515)274-9973 Fax

623 W. Broadway #102 Council Bluffs, IA 51503 (712) 256-9930 (712) 256-9931 Fax

3750 Sepulveda Blvd. Torrance, CA 90505 (310) 378-4088 (310) 376-2748 Fax

11109 So. 84th St. #1850 Papillion, NE 68046 (402)593-3575 (402) 593-3576 Fax

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