Your Assessment

Onine Assessment

• Name
  *

• Address

• Phone Number
  *

• Email Address
  *

• Have you had a powerchair before?NoYes

• If yes, which model did you have and how did you get on with it?

• Do you have any medical conditions?

• How does it affect you?

• Weight
  *

• Height
  *

• Do you wish to travel in the chair in a motor vehicle?

• Indoor or outdoor use or both?IndoorOutdoorBoth

• Terrain to be used on?

• Any history of pressure care problems?

• Type of cushion you use

• Time spent in chair

• Any other information