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eSpecial Needs :: Stroller Chart

Stroller Measurement Chart Form

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What is his/her overall height?
What is their overall weight?
Age?
Can he/she sit up on his/her own?
Model of Stroller?
Stroller Style:
Will stroller/pushchair need to meet crash tests for bus transport? Yes   No
Does the seat need to tilt and/or recline? Yes   No
Does he/she need armrests on the chair? Yes   No
Does he/she thrust his pelvis to move out of the chair? Yes   No
Do his legs scissor in or out? Yes   No
Are foot positioners needed to adjust foot position and angle? Yes   No
Do feet need to be strapped down to footplate? Yes   No
Do his/her legs need to elevate? Yes   No
Does he/she require support for his chest and trunk to hold him up and in place? Yes   No
Does he/she require lateral support to prevent from leaning? Yes   No
Does he/she require support for his/her head? Yes   No
Is a sunshade needed? Yes   No
Will a tray be needed? Yes   No
Will basket or holders for oxygen tanks be required? Yes   No
     Measurement
A - Shoulder Width
B - Hip Width
C - Seat To Top Of Head
D - Seat To Shoulder
E - Seat To Inside of Knee
F - Back Of Knee To Back Of Heel
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