26
THE RADCLIFFE WHEELBASE
3
User/Carer Handbook
1
RADCLIFFE WHEELBASE CHASSIS NUMBER & SUPPLY INFORMATION
Wheelbase CHASSIS NUMBER
_____________________________________________________________________________
Date Supplied By Radcliffe
_____________________________________________________________________________
TO BE COMPLETED BY THE WHEELCHAIR SERVICE :
WHEELCHAIR CENTRE NAME
_____________________________________________________________________________
CONTACT NAME
_____________________________________________________________________________
WHEELCHAIR CENTRE TELEPHONE NUMBER
_____________________________________________________________________________
Client REFERENCE NUMBER
_____________________________________________________________________________
USER NAME
_____________________________________________________________________________
ADDRESS
_____________________________________________________________________________
_____________________________________________________________________________
DATE SUPPLIED TO USER
_____________________________________________________________________________
TYPE OF SEAT FITTED
_____________________________________________________________________________
