Standard
Tilting
Rigid
Folding
Accessories
Front Wheel Drive
Rear Wheel Drive
Mid Wheel Drive
All Terrain
Cushions
Back Supports
Power Wheelchairs
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Beds
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Early Intervention Paediatric
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Adjustable Beds
Foam
Air
Latex
Pressure Care Overlay
Chairs
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Slings
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Manual Handling
Quickie Xtender
Alber Viamobil
SmartDrive MX2+ Pushtracker
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Breezy P100
Mobile Commodes
Power Lift Chairs
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Date of Birth*
A copy of this application will be sent to this address
What is the expected funding source for this item?
How is the client’s NDIS plan managed?
What are the key requirements in a bed? (Select all that apply)
Do you require Lightning Mobility to supply a mattress?
What type of mattress?
What size bed does the client want?
Please note: some funding bodies may only fund bed sizes above king single in exceptional circumstances.
Specify custom sizes if required or known
A Back rest size
B Fixed
C Small Kneebreak
D Large Kneebreak
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