Engineers Form
Measurement A
*
From top nose to floor
Measurement A proof photo
*
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Measurement B
*
From top nose to end of wall
Measurement C
*
Between one step diagonally
Measurement D
*
From bottom nose to end of wall
Measurement E
*
Width of stairs
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Looking up the stairs, which side of the stairs would the stairlift fit
*
Please Select
Left
Right
Does the rail need joining?
*
Please Select
Yes
No
Does the rail need a hinge?
*
Please Select
Yes
No
Amount of steps?
*
Nearest power supply
*
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Image 1
*
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Image 2
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Image 3
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Image 4
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Image 5
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Engineers Name
*
Customer Name and Address
*
Engineer email
example@example.com
Users approximate weight
*
Can user bend knees
*
Please Select
Yes
No
Can user use both arms/hands
*
Please Select
Yes
No
Anything we should know?
*
Please check users weight and height if stairs narrow
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