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Attachment Review
Product Information:
Item Name:
*
Item Description:
*
Battery Life:
(Powered Items Only!)
Where Did You Buy This Item?
*
Personal Opinion:
*
Please Rate The Following Features:
How Comfortable Is This Item To Use?
*
1 Star
2 Stars
3 Stars
4 Stars
5 Stars
(Consider how long you can sit in it!)
How Easy Is This Item To Attach/Remove?
*
1 Star
2 Stars
3 Stars
4 Stars
5 Stars
(Consider how quickly you can secure the item to your wheelchair!)
How Easy Is This Item To Transport?
*
1 Star
2 Stars
3 Stars
4 Stars
5 Stars
(Consider how easy it is to get in and out of a car or WAV!)
How Does This Item Cope Off-Road?
1 Star
2 Stars
3 Stars
4 Stars
5 Stars
(Consider if it can go on grass or a bumpy pathway!)
Overall Rating:
*
1 Star
2 Stars
3 Stars
4 Stars
5 Stars
(How does the item meet your needs, lifestyle and preferences?)
Photo Upload:
Image Upload:
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Maximum upload size: 8.39MB
Image Upload:
Drop a file here or click to upload
Choose File
Maximum upload size: 8.39MB
Image Upload:
Drop a file here or click to upload
Choose File
Maximum upload size: 8.39MB
Image Upload:
Drop a file here or click to upload
Choose File
Maximum upload size: 8.39MB
Image Upload:
Drop a file here or click to upload
Choose File
Maximum upload size: 8.39MB
Personal Information:
Name:
*
Email
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Diagnosis:
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First Name
Last Name
Condition/Disability
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Attachment Review Form
