EVALUATION FORMS
Our evaluation forms help identify the right bike or chair configuration, guiding parents, therapists, dealers, and users through available customization options and accessories to fit each individual’s needs.
Frame Runner Evaluation Form
ET2611 Evaluation Form
Chill-Out Chair Rock’er Evaluation Form
Chill-Out Chair Roll’er Evaluation Form
ASR2011-HD Evaluation Form
ASR2011 Evaluation Form
ASR16 Evaluation Form
EHDU20 Evaluation Form
EHDU16 Evaluation Form
EHDU12 Evaluation Form
Defier Evaluation Form
DCP Mini Evaluation Form
DCP16 Evaluation Form
DCP12 Evaluation Form
AS2600 Evaluation Form
AS2000 Evaluation Form
FIND YOUR FIT
FUNDING & FINANCING
MEDICAL JUSTIFICATION
The client’s diagnosis, specific impairments resulting from the patient’s diagnosis, and how the device will address or benefit the specific diagnosis and resulting impairments are information that insurance providers require. You must additionally provide a written explanation of the diagnosis along with the applicable code in the letter. To facilitate the approval process, describe how the device or equipment you are requesting can improve the patient’s impairments. Also, emphasize the long-term benefits as they are very important.


