Online Assessment Form | Accro Clearline

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Online Pre-Assessment Form

Your Name

Service User's Name - If Applicable

Phone

Funding Source:

Service User's Address

User's vulnerablity to pressure sores:

Are there any postural challenges we need to be prepared for?

Any additional information that we should be aware of?

1: Seat Width (maximum width from outer edge of thighs)

2: Seat Depth (from behind knee to outer edge of back or seat, whichever is greater)

3: Floor to Seat Height (from heel to underside of knee)

4: Are feet pointing downwards (foot drop/plantarflexion) or upwards?

5: Back Height (from seat to top of head - when sitting up straight)

6: Armrest Height (top of seat to underside of forearm)

disclaimer: additional information may be required after submission. In this case, Accro Clearline will contact you directly to collect this. Once we have all the information required, a rough price guide will be given.

Once form has been submitted, it will be reviewed and you will be contacted shortly after to discuss face to face Seating Assessment options. Seating assessments are FREE OF CHARGE, we WILL NEVER ask for payment over the phone to book a face to face Seating Assessment.

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📞 01722 410387

Online Pre-Assessment Form