Grab Bar Intake Form
Grab Bar Work Order:
Request date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grab Bars
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Ergonomic Assessment & Site Inspection
$
100.00
CAD
18'' Grab Bar - Knurled, Rotating Flange
12118RF-DRI
$
40.00
CAD
Quantity
1
2
3
4
5
24" Grab Bar - Knurled, Rotating Flange
12124RF-DRI
$
44.00
CAD
Quantity
1
2
3
4
5
32" Grab Bar - Knurled, Rotating Flange
12132RF-DRI
$
46.00
CAD
Quantity
1
2
3
4
5
Grab Bar Anchors - ADA Compliant
In case of no wood stud, anchors must be used to secure grab bars. 2 anchors are needed per grab bar
$
15.00
CAD
Quantity
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Grab Bar Installation
$
175.00
CAD
Quantity of Grab bars to be installed
1 bar Installation
2 bars Installation
3 bars Installation
4 bars installation
Type a question
Visa
Mastercard
*Charge will only occur on the day of service. Ergonomic Assessment and Site Inspection fee is non-refundable. We will contact you to review the details and confirm appointment.*
Signature
Submit
Kanata
Hazeldean Mall 17 - 300 Eagleson Road Kanata, ON K2M 1C9
Barrhaven
Medical Centre 205 - 16 Green Street Nepean ON K2J 3R2
Downtown
The Doctor's Building 120 - 267 O'Connor Street Ottawa, ON K2P 1V3
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