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  • 5110 Atlantic Avenue, Raleigh, NC 27616

Wheelchair Quantifier

Wheelchair Measuring GuideIn order to ensure that your wheelchair will sufficiently fit in your converted vehicle, we need for you to fill out the following quantifier form. We know there are a lot of questions, but they are all important in determining a correct fit. Use the example graphics below for items marked A-N. You’ll also need to attach a picture of the person in their power chair at the end of the form.

If you’d like to download the worksheet to print out, click here.

 

* = Required Fields
Your Info







Vehicle Info









Wheelchair Info
Wheelchair Quantifier Example














Additional Comments


This guide is to be used to determine if the client fits in the vehicle with the chair submitted. It is not to be used to determine if the driving position will be satisfactory to the client. ATC shall not be held liable for driving position issues.