Contact wheelchair hire on 01642 353 420

Please complete the form below to design and hire your made to measure wheelchair

Measurements:

If you would like a qualified practicioner to take the measurements for you simply ignore the measurements box and tick 'Assessment of need by qualified assessor' box in the options section and we will arrange the visit accordingly.

	Measure the distance from hip to hip. You should fit comfortably into the chair inches More Info...If the seat is too wide, users often lean more to one side in order to feel supported. If the seat is too narrow, it will be uncomfortable and may give pressure sores.		Measure the distance from the back to the underside of the knee inches More Info...If the seat is too short, the thighs will not be supported and pressure will be transferred onto the buttocks. If the seat is too long, it may cause undue pressure behind the knee and the user may not get adequate support from the backrest.		Measure distance from back of heal to underside of thigh inches More Info...The height of the footrests on the wheelchair should be set so that they support the legs and feet and, in turn, the underside of the thighs. This will reduce pressure on the buttocks. If the footrests are too high pressure under the buttocks is increased. If the footrests are too low the user's knees will be lower than the hips and pressure will build up under the thighs.

	Measure the distance between the seat and middle of shoulder blade inches More Info...The upper body is stabilised by the support from the backrest, which should be high enough to stabilise the upper lumbar region. Above this level, the backrest height is a matter of personal preference.		Measure distance between the seat and underside of forearm inches More Info...Armrests should support the user's forearms with the elbows at 90°. If they are too high, the user's shoulders will be hunched; if they are too low, the user will tend to slump to one side.		Occupant wieght kg/stones More Info...The weight of the user must be entered. If the user is over 135KG (21 stone) the wheelchair will be reinforced to withstand the extra loading for safe functioning. If a non reinforced chair is used by a hirer over 135KG all warranties will be invalidated and any damage resulting would be at the cost of the Hirer.

Options:

Elevating leg rest (left) - £6 per week		Armalite safety lighting system - £2 per week
Elevating leg rest (right) - £6 per week		Oxygen carrier - £6 per week
Stump support (left) - £5 per week		Lap belt - FREE
Stump support (right) - £5 per week		Reinforcing over 135kg (20stone) - £10 per week

Personal Details:

*Full Name:

Tick this box if you would like an assessment by one of our qualifed assessors:

£100 one off charge

*Telephone N°:

*Email:

*Address 1:

*Address 2:

*Town/City:

*County:

*Post Code:

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