Life After SCI DVD Request

Clinicians, If your newly injured clients are not ready to watch these videos in rehab, we encourage you to give them copies to watch at home. Feel free to reorder as needed (a reorder form is included with each DVD).

Wheelchair users and their friends and family are also welcomed to request a DVD.

To receive your free "Life After SCI" DVD, Please fill out all information that applies to you. Thank you.

I am a:
If other, please specify:
How did you learn about the "Life After SCI" DVD:

If other, please specify:

Full Name:
Title/Diagnosis:
Facility/Company:
Address:
	Home address Facility address
Address 2:
City:
State:
Zip:
Phone:
Email:
	Send me the monthly "Standing Room Only" Newsletter

Clinicians, How many dedicated SCI beds does your facility have?

Clinicians, Do you prescribe a stander for your clients after they leave rehab?

Clinicians, What stander(s) do you prescribe or use in your facility?

Endusers, Did your therapist prescribe a standing frame for you to use at home?

Endusers, What type of stander do you own?


Please send Free "Life After SCI" DVD
	Quantity:
	1 (we will send endusers 1 video)
	5
	10
	Other

	Please send more information:
	Standing Technology Catalog
	DVD - Complete Standing Series Video
	Funding Guide to Standing Technology
	U.S. Retail Pricebook and Order Forms
	Benefits of Standing Poster (great for clinicians)
	Standing 101 Home Study Course (great for clinicians)

	Please contact me regarding a free demonstration of an EasyStand product.
	Any other comments or questions?


	Fields in bold are required.


	Customer Service: 800-342-8968 \| International: 507-697-6393 \| Funding Hotline: 877-844-1172
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