27
Patient’s Measurements
(See Diagram Below) cm___ inch___
1) Hip Width _______
2) Seat Depth _______
3) Foot Drop left __ right___
4) Top of Shoulders
to Seat _______
1
3
left
2
4
right
3
Office Info. Only:
What type of wheelchair
would you suggest?
____________________
Person filling out form
____________________
Before picture
After picture
4135 Valley Commons Dr.
Suite D.
Bozeman, Montana, USA
59718
[email protected]
www.rocwheels.org
29
Summary of Contents for Rockit
Page 1: ...USER GUIDE ...
Page 22: ...22 Wheelchair Safety ...
Page 23: ...23 ...
Page 24: ...24 ...
Page 44: ...44 P O Box 11765 Bozeman Montana USA 59719 Info ROCWheels org www rocwheels org ...