FREE ANALYSIS AND CONSULTATION
  

Please fill in the below questionnaire to give us an idea 
of your current problem/issue - the more you can detail 
the bigger probability that we will be able to respond.

Your Name: Required Field
Company:
Email: Required Field
Phone:
Fax:
   
Tell us about the person using mobility aids and his/her level of mobility impairdness:

 
1, 2 or 3 person transfers - specify make of product/s and type of transfer:
 
Mechanical lifting devices - specify make of product/s and type of transfer:
 
Transfer Board - specify make of product and type of transfer, individual or assisted:

 
Gait Belt - specify make of product and type of transfer:

 
Pivot Disc - specify make of product and type of transfer:

 
Patient Sling - specify make of product and type of transfer:

 
Slide Products - specify make of product and type of transfer:

 
Gurneys - specify make of product and type of transfer:

 
Other - specify make of product and type of transfer:

 
Summary of your comments and what you would like to improve upon:

 

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