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Online mobility scooter advice
Weet u niet welke rolstoel u aan moet schaffen? Vul dan dit formulier in. Een van onze medewerkers zal u zo snel contacteren met een bijpassend advies. Let wel op dat dit advies puur indicatief is, en niet als medisch advies gezien moet worden.
Name
Postcode
Number
E-mail *
Phone number
My age:
My weight
My seat width:
My seat height:
My seat depth:
How much do you use the scooter?
Daily 1 - 2 hours
Daily 2 - 4 hours
Daily the whole day
Weekly once or twice
Monday once or twice
What do you use the scooter for?
Occasional use
Every day use
Other:
Do you use the scooter inside or outside?
Inside
Outside
Both inside and outside
I want to use the scooter on:
Asfalt
Klinkers / Kasseien
Bosgrond
Other:
What is important to you:
Gebruikersgemak
Gebruikers gewicht
Vouwbaarheid
Vering
Zitcomfort
Other:
Additional Options:
Mandje
Spiegel
Voetgas
Stokhouder
Kilometerteller
Other:
Other comments:
Available on
08:00 - 12:00
12:00 - 15:00
15:00 - 17:00
Best way to contact you:
Phone
E-mail
Mail
Enter the four dark symbols below:
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