corner Chair

Use the Corner Chair graphic to fill in the necessary measurements and information below. Then simply "Submit" it to us. If you have any questions, feel free to call or email us. We will be in touch.

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Person recommending equipment

First Name

Last Name

Your Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Client's Name

First Name

Last Name

Client's Birthdate

Seat to top of shoulder

Seat to armpit

Seat to 90 degree elbow

Floor to back of knee

Seat back to back of knee

Length of shoe

Belly circumference

Chest circumference

Shoulder width

Foot Placement

Seat Belt

Abductor

1" Foam Padding

Vinyl Color

First and Second choice of color

Table

Special Instructions

Anything else you want us to know

corner Chair

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special Needs Solutions is a tax-exempt 501(C)(3) nonprofit organization. Your gift is tax-deductible as allowed by law.