Order form – Smart™

Order number:
Order Date:
Company name / Name and surname
Bill adress:*
E-mail:*
Phone*
-
Click if:
Ship to:
Shipment adress:
Contact:
-
Ship product:*
Product size*

Standard Equipment

  • Frame with castors and brakes
  • Footplate with foot stabilization
  • Knee support
  • Pelvic brace with pelvic belt
  • Chest brace with chest belt
  • Tray

Accessories:

Safety:
Positioning:
Comfort:
Message to us: