Special Needs Solutions

Standing Table

Use the Standing Table graphic to fill in the necessary measurements and information below. Then simply "Submit" it to us. If you have any questions, feel free to call or email us. We will be in touch.

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Person recommending equipment

First Name

Last Name

Name

First Name

Last Name

Email Address

Phone

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Client's Name

First Name

Last Name

Client's Birthdate

Floor to Crown of Hip

Floor to Bent Elbow

Foot Length

Hip Width

Bottom to Belly

Depth, front to back

1" Foam Padding?

If so: Indicate where, and vinyl color preference

Special Instructions

Anything else you want us to know

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Standing Table

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