Children's Assistive Technology Service
Therapy Equipment
Wrist Supports
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Wrist Supports

$0,00
$00,0
SKU:
10101106671937
Items available:
0

Size: Extra Small

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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
Parent/Guardian Phone
Parent/Guardian Email

Therapist Info

Therapist Name
Therapist Phone
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?
Which of the following reflects your level of satisfaction with this means of obtaining needed equipment?
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Please Note:

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.

Required Equipment Release Form
Liberación de Equipo

Equipment Release

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