What's your name?
*
Source
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What's your email?
*
example@example.com
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What is your phone number?
*
Please enter a valid phone number.
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What is your age?
*
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Do you currently use a mobility scooter?
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a) Yes
b) No
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How often do you use your current mobility scooter?
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a) Every day
b) More than 3 times a week
c) Once or twice a week or less
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What is your height (in cm)?
*
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What is your weight (in kg)?
*
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What is your primary reason for needing a mobility scooter?
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a) To go shopping
b) To visit friends within a 5 kilometer area
c) To go outdoors more
d) Something else
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How far do you typically travel on your mobility scooter?
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a) Less than 5KM
b) Between 5-10 KM
c) More than 10 KM
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Do you primarily use your mobility scooter indoors or outdoors?
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a) Indoors
b) Outdoors
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What type of terrain do you typically encounter while using your mobility scooter?
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a) Mainly indoors and on pavements
b) Rough ground
c) A mixture of all the above
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How important is speed to you when selecting a mobility scooter?
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a) Very important
b) Somewhat important
c) Not important
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How important is range (i.e. how far you can travel on a single charge) to you when selecting a mobility scooter?
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a) Very important
b) Somewhat important
c) Not important
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Do you need a scooter that can fold up for easy transport?
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a) Yes
b) No
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How important is comfort (i.e. seat padding, back support, etc.) to you when selecting a mobility scooter?
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a) Very important
b) Somewhat important
c) Not important
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How important is manoeuvrability (i.e. how easy it is to turn and navigate through tight spaces) to you when selecting a mobility scooter?
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a) Very important
b) Somewhat important
c) Not important
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Have you ever customized a mobility scooter before?
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a) Yes
b) No
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Are you NDIS funded?
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Yes
No
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What is your budget for a mobility scooter?
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a) $2,000 - $5,000
b) $5,000 - $7,500
c) $7,500 - $10,000
d) More than $10,000
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How would you like us to contact you?
*
Phone call
Email
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Wonderful. Based on your answers, we have a solution for you. As we know this is a big decision, we have a mobility specialist ready to answer any further questions you have and walk you through our recommendation. What is the best time of day to contact you?
*
Morning
Afternoon
Evening
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Thank you for completing the assessment.
Please click the Submit button to complete the survey.
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