Grab Bar Intake Form

Grab Bar Intake Form
Grab Bar Work Order:
Request date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grab Bars
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Ergonomic Assessment & Site Inspection
$100.00CAD



18'' Grab Bar - Knurled, Rotating Flange
12118RF-DRI

$40.00CAD Quantity



24" Grab Bar - Knurled, Rotating Flange
12124RF-DRI

$44.00CAD Quantity



32" Grab Bar - Knurled, Rotating Flange
12132RF-DRI

$46.00CAD Quantity



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

$15.00CAD Quantity



Grab Bar Installation
$175.00CAD Quantity of Grab bars to be installed



Total

$0.00CAD
Type a question

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*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
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
Should be Empty:

Kanata