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Bath Chairs/Toileting Commodes Form

Choosing the right bath chair, toileting commode or sit-to-stand stander is essential to the safety of the user. Not having the right measurements could mean you miss out on an important feature or accessory that could keep your client or loved one secure.

This form is designed to guide you through the process of finding the measurements needed to ensure comfort, safety and function, as well as ask important questions related to the type of product you’re interested in. Once submitted, our customer service representatives will look over your information and send a list of suggested products and accessories that fit your needs.

First Name: *
Last Name: *
Organization:
Title:
Address: *
City: *
State: *
Country: *
Zip/Postal Code: *
Phone *
Email Address: *
Yes, I would like to receive eNews from eSpecial Needs.
What is the User's Overall Height?:
What is the User's overall weight:
Age:
Which product were you interested in?:
Model of Product:

For Bath Chairs:

Is the seat for a bath tub or roll in shower?:
Yes No
Is a tub stand needed?:
Yes No
Is a shower stand needed?
Yes No
Is a transfer system needed to get the user into the seat in the tub?:
Yes No
Can he/she sit up on their own?:
Yes No
Does the bath chair also need to be used as a commode?
Yes No

For Toileting:

Which style of commode is needed?:
Can he/she sit up on their own?:
Yes No
Does the commode also need to be used as a bath chair?:
Yes No

Measurement

A - Shoulder Width:
B - Hip Width:
C - Seat To Top Of Head:
D - Bottom Of Seat To Shoulder:
G - End of Seat To Inside of Knee:
H - Back Of Knee To Bottom Of Heel:
I - Overall Height: