WheelDirectOS — Dashboard

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Fill in what you know. Every field is optional except name.

Contact Information

First Name *

Last Name *

Phone

Date of Birth

Current Chair

Make

Model

Age (years)

Mobility Needs

Primary Diagnosis

Living Situation

Primary Use

Mobility Needs & Goals

Body Measurements (if available)

If you have your measurements ready, enter them below. If not, we'll go over them during your consultation. You'll need at least a measuring tape — having someone to help you measure is also recommended.

Seat Width (in)

Seat Depth (in)

Back Height (in)

Seat-to-Floor (in)

Leg Length (in)

Hip Width (in)

Trunk Width (in)

Weight (lbs)

Skin Integrity

This helps us recommend the right cushion for you.

History of pressure sores/wounds?

Current skin concerns?

Hours/day sitting in chair

Currently use a pressure-relief cushion?

Sensation level

Notes

Internal Notes