Children's Assistive Technology Service
Standers
Prime Engineering Superstand, Youth
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Prime Engineering Superstand, Youth

$0,00
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SKU:
10101116174657
Items available:
0
Made by Prime Engineering
  • Size: Youth
  • User Height: 40-60"
  • Headrest, Chest Harness, Foot Straps
  • Tray
***Equipment must be recommended / fit by a professional PT/OT/ATP***
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Our Sponsors

C.A.T.S. provides for the re-use of pediatric rehabilitation equipment and assistive technology devices in Virginia. We serve as a no-cost resource for children with disabilities who need adaptive equipment and whose families have limited resources.

EIN

a 501(c)3 public charity
EIN: 46-4866068

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The below information is required for our record keeping and equipment fitting purposes.

Parent/Guardian Info

Parent/Guardian Name
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Therapist Info

Therapist Name
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Therapist Email

Child Info

Child Name
Race
Age
Height
Weight

Other Info

Why did you choose to obtain an AT device/service from our program?
What type of insurance does the child have?
Has the requested equipment been denied by Insurance?
Persons in Household
Family Income Range
Is this child currently a client of the Department of Aging and Rehabilitative Services (DARS)?
Diagnosis
The primary reason for which the child and family needs an AT device or service is related to:
Will equipment be used at home, school or both?
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The fields above are required to complete your equipment request. We also require a signed Equipment Release Form to process your request. Please sign the Equipment Release Form at the button below.

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Liberación de Equipo

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