EZ-P Custom Fit Consultation

✓

Request received.

We'll reach out within 48 hours via your preferred contact method to complete your fit consultation.

Our team reviews your positioning profile

We contact you within 48 hours

Brief 10–15 min consultation call or email exchange

We help you finalize the right EZ-P configuration

01 — Your Contact Information

First Name ✦ Please enter your first name

Last Name ✦ Please enter your last name

Email Address ✦ Please enter a valid email address

Phone Number (optional — for call consultations)

Preferred Contact Method ✦

📧 Email 📞 Phone call 💬 Text message

Please select a preferred contact method

02 — Your Cushion & Chair

Current Cushion Size ✦ Please select your cushion size

Chair Type

Current Cushion Type / Brand (optional) This helps us understand your current seating setup

03 — Seated Pelvic Position

How would you describe your seated pelvic position? ✦ Please select your pelvic position

Do you have a current seating prescription or OT/ATP on file?

Yes — active OT/ATP Previously, not current No

04 — Spinal Profile & Trunk Asymmetry

Which of the following apply to you? (select all that apply)

No spinal curvature or trunk asymmetry

Mild scoliosis Diagnosed but minimal functional impact on seated position

Moderate to severe scoliosis Visible trunk lean or rotation affecting seated symmetry

Kyphosis Pronounced forward hunch of the upper spine

Spinal fusion Fixed spinal position limiting trunk mobility

Other trunk asymmetry Another condition affecting your seated trunk positioning

Any additional details about your spinal condition? (optional)

05 — Primary Diagnosis

Primary diagnosis or reason for wheelchair use (optional — select all that apply)

Spinal Cord Injury

Multiple Sclerosis

Stroke

Muscular Dystrophy

Cerebral Palsy

ALS / MND

Spina Bifida

Other / Prefer not to say

06 — Anything Else We Should Know

Additional context about your positioning or anatomy (optional)

Best time to reach you (optional)

No obligation · Our team responds within 48 hours
EZ-P™ · Patent US12,011,402 B2 · FDA-Registered Class I Medical Device

Your custom fitconsultation request

Request received.

Your custom fit
consultation request