Comfort Quote Request
Please make sure this is completed correctly. If wrong, the quote will be wrong.
Please tell us what are geographical area you are from.
Name of OT
OT Email Address
OT email address.
OT Phone Number
Initials of client
Have we completed an assessment?
If the quote is for a retail client please select below option.
Comfort Chair Size
What chair is required?
Small - CHAIR-0-CM1-140
Medium - CHAIR-0-CM1-240
Large - CHAIR-0-CM1-340
What depth is required.
Please note that a depth adjustment kit will only be added for 16" and 14".
20" - Bracket Selction - DA20-0-CM1-000
18" - Bracket Selection - DA18-0-CM1-000
16" - Add KITDA-0-CF1-000 & DA18-0-CM1-000
Chair Height - Is a HAK Required?
Yes - Add part number: KITHA-0-CM1-100
Visco - STD
What posture option is required?
VP Waterfall Backrest - STD
Pr - Lateral Supports - MALLS-0-CF1-000
Lateral Support Backrest - Select Correct Size
Adjustable Lateral Support - Select Correct Size
Profiled Headrest - HPRF-0-CM1-120
See notes below for specials
Armrest Overhang Setting
Please select the armrest overhang setting
External - STD
Please select the handset setting.
Right - STD
Please select the rise setting.
Flat Rise is not available on Small.
Rise - STD
Medium Rise -
Flat Rise -
Any other notes that should be added to the quote.
Quote Requested by
(Internal Use Only)
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