Wheelchair Manufacturers in Canada | Wheelchair Canada

PERSONAL FORM BACK

Online quote form

STANDARD SIZES

Gentle Fit Back Custom Width:*

Gentle Fit Back Custom height:*

Gentle Lateral Custom:*

ADDITIONAL OVERLAYS

SHUFOLV1 Visco Overlay Half (3 Pieces)

SHUFOLV2 Visco Overlay Full (6 pieces)

SHUFOLG1 Gel Overlay Half (3 Pieces)

SHUFOLG2 Gel Overlay Full (6 Pieces)

PIN OPTIONS?

COVER OPTIONS

EXTRA COVER*

SHUFCOV3 Standard Cover

SHUFCOV4 TEK4 Infection Control Complete Cover

SHUFCOV8 TEK4 Infection Control 4" Bottom Protector

SHUFCOV5 Custom Cover

*Note: Please enter the size above for standard or custom cover

Custom Cover:*

Custom Cover sizes:* *Note: Please enter the size above for standard or custom cover

Additional Notes

Final Total

First Name*

Last Name*

Company Name:*

Phone Number:*

Official Work Email*
Location:*