Get Wheelchair Assessment Order Form

Filling out the Wheelchair Assessment Order Form online is a straightforward process designed to ensure accurate assessments for individuals who require wheelchair services. This guide will walk you through each section of the form step-by-step, providing clear instructions to help you complete it efficiently.

Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by providing the client's information in the designated section, including the client's name.
3. In the payer's contact information area, fill out the name of the individual responsible for billing, along with their contact details such as address, city, province, and postal code.
4. Enter the height and weight of the client in the specified fields to ensure accurate wheelchair specifications.
5. For wheelchair specifications, complete the body mechanics section by filling in the seat width, depth, back height, and seat-to-floor measurements.
6. Indicate the type of mobility required by selecting between Manual and Power wheelchair options and provide details about the specific type.
7. Complete the seating and additional comments sections by detailing any physical considerations or specific equipment needs.
8. Lastly, fill in the contact therapist's phone number, fax number, organization's name, and email before reviewing the form for completeness.
9. Once all sections are filled out, you can save changes, download, print, or share the completed form as needed.

Take the next step in the process by completing the Wheelchair Assessment Order Form online today.