Children's Assistive Technology Service
Adaptive Seating
Rifton Standard Base
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Rifton Standard Base

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SKU:
10101106213185
Items available:
0

Standard Base for Rifton Activity Chair 860 with Tilt in Space

***Not a Hi-Lo Base****

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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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Parent/Guardian Info

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Therapist Info

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Child Info

Child Name
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Age
Height
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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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