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Seating Measurement Chart Form

Providing comfort and security in an assistive and adaptive seating solution meant for a client or loved one with special needs isn’t difficult with the right information. Knowing the measurements and specific needs of the user can make all the difference.

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/Province *
Country *
Zip/Postal Code *
Phone *
Fax
Email *
Yes, I would like to receive eNews from eSpecial Needs
What is his/her overall height?
What is their overall weight?
Age?
Model of Seating System?
Seat Style:
Does he/she thrust their pelvis to move out of the chair?
YesNo
Do their legs scissors in our out?
YesNo
Do feet need to be strapped down to footplate?
YesNo
Does he/she require support for his/her chest and trunk to hold them up and in place?
YesNo
Does he/she require lateral support to prevent from leaning?
YesNo
Does he/she require support for his/her head?
YesNo
Will a tray be needed?
YesNo
Does the chair need casters to be mobile?
YesNo
Do you need a seat insert or a free-standing seating system?
YesNo
What other type of support will user require?
     Measurement
A - Shoulder Width
B - Hip Width
C - Seat To Top Of Head
D - Bottom Of Seat To Shoulder
E - Bent Elbow To Floor
F - Bent Elbow To Bottom Of Seat
G - End Of Seat To Inside Of Knee
H - Back Of Knee To Bottom Of Heel