Client Name: ___________________________________________

Contact Name: _________________________________________

Address: ______________________________________________

______________________________________________________

Telephone No: _________________________________________

Fax No: _______________________________________________

E-mail: _______________________________________________

EASyS Advantage Pushchair Assessment Form

SPECIFICATIONS

EASyS Advantage Pushchair

ACCESSORIES

Tendercare Ltd PO Box 3091 Littlehampton BN16 2WF Tel 01903 726161 Fax 01903 734083 Email info@tendercareltd.com

Complete includes:- EASyS Seat unit with BSS®(Balance Safety System), Adjustable knee and hip angle, Padded Upholstery, Standard Lap Belt, Adjusta-ble Side Pads, Footrest and Shopping Basket (Max carrying capacity 3kg) (plus calf strap on size 2 only) EASyS Advantage Chassis with swivel front wheels and swivel lock, Height Adjustable Push Bar with Soft Grip, Tilt-in-Space adjustable without fixed positions, Lockable Seat Suspension, Set of Tie Down Transportation Brackets.

Please tick model required: Note: The EASyS Advantage Pushchair has been impact tested and is suitable for use as a vehicle seat. It is supplied with the set of 4 Tie Down Transportation Brackets fitted.

MODEL/SIZE Part No EASyS Advantage Pushchair Size 1 (Complete) with Transit System TH6601/4 (Maximum carrying weight of occupant and all accessories 40kg)

EASyS Advantage Pushchair Size 2 (Complete) with Transit System TH6701/4 (Maximum carrying weight of occupant and all accessories 40kg)

Pneumatic Wheels - Upgrade Kit TH6647

1" Sacral Pad (uncovered - underneath cover) TSS0434

Seat Wedge Pad *Will need cutting to size upon receipt TS6314

Calf Strap - EASyS Size 1 TH6635/4

Heel Straps - Fits both sizes - Pair (Cam Buckle) TS6592

Toe Straps - Fits both sizes - Pair (Cam Buckle) TS6591

Grip Rail - EASyS Size 1 TH6621/4

Grip Rail - EASyS Size 2 TH6721/4

Playtray (Transparent) - EASyS Size 1 TH6628

Playtray (Transparent) - EASyS Size 2 TH6728

Sun Canopy (Umbrella Style) - Fits both sizes TH6594

Sun/Rain Cover (Hood & Leg Cover) TH6637/4

Sun/Rain Cover (Hood Only) ** TH6637/61

Transparent Rain Shield for Sun/Rain Cover ** TH6739 ** These parts must be ordered together to form a complete rain cover

Raincover (Transparent) - EASyS Size 1 & 2 TH6638/4

Accessory Bag - Fits both sizes TH6639

Sleeping Bag (Winter) - EASyS Size 1 TH6618/4

Sleeping Bag (Winter) - EASyS Size 2 TH6718/4

Frame Padding - Fits both sizes TH6622/4

Foam Pad for Footboard (Covered) 1" - Size 1 TH6650

Foam Pad for Footboard (Covered) 2" - Size 1 TH6661

Foam Pad for Footboard (Covered) 1" - Size 2 TH6649

Foam Pad for Footboard (Covered) 2" - Size 2 TH6660

Vent Tray- EasyS Advantage Size 1* TH6294 *Max carrying weight 5kg

Vent Tray- EasyS Advantage Size 2* TH6494 *Max carrying weight 5kg

Specifications Size 1 Size 2

Seat Depth 190-300mm 270-380mm

Seat Width 190-310 mm 250-370 mm

Back Height 415-650 mm 550-740 mm

Lower Leg Length 175-290 mm 210-370 mm

Seat Back Recline 90º-180º 90º-180º

Knee Angle 90º-180º 90º-180º

Foot Angle 78º-100º 78-100º

Footrest (w x d) 280 x 180 mm 320 x 210 mm

Seat Tilt -10º- +35º -10º - +35º

Total (l x w x h) 1000 x 600 x 1040mm 1110 x 705 x1 110mm

Folded (l x w x h) 820 x 595 x 425mm 1070 x 690 x 1200mm

Weight 18.8 kg 21.3 kg

Carrying Capacity 35 kg 40 kg

Upholstery Colour Black with Blue, Black, Green,

Magenta & Red

Black with Blue, Black, Green,

Magenta & Red

TRUNK SUPPORTS

Page 1 of 3

EASyS Advantage Pushchair

(All Dimensions in mm) A B

Lateral Trunk Supports Size 1 TH6634/4

130 130

Lateral Trunk Supports Size 2 TH6734/4

150 170

Lateral Trunk Supports with Chest Belt (Fits both sizes)

TH6633

220 100

Lateral Trunk Supports with Chest Belt

Lateral Trunk Supports

Kinetic Balance® ANKLE CUFFS* (Hook & Loop Release) - Ankle Circumference (A)

HEADREST

Lateral Head Supports

(All Dimensions in mm)

A B C D E F

Recess 265 140 90 60 - TH6625 55

Extra Recess 265 140 90 80 - TH6626 55

Extra Recess with curved sides

TH66267 265 140 90 80 - 40

Occipital Roll 265 130 90 60 80 TH6627 40

Lateral Head Size 1

110 130 - - - TH6624/4 -

Lateral Head Size 2

140 150 - - - TH6724/4 -

Page 2 of 3

POMMEL

(All Dimensions in mm) A B C

Pommel (Size 1) TH6620/4 100 60 90

Pommel (Size 2) TH6720/4

110 70 105

STANDARD HARNESS (NON Flexible) See above diagram for measurements

Seat Waistcoat (Small) TH6631/4

Seat Waistcoat (Medium) TH6632/4

Seat Waistcoat (Large) TH6731/4

H Belt Harness - Fits both sizes TH6629/4

Groin Adaptation Strap* TH6233 *Requires H Harness or 2 point Hip Belt for fitting

Centre Pull 2 pt Hip Belt (metal push button) Extra Small KB6.70003.0

Centre Pull 4 pt Hip Belt (metal Push Button)Extra Small BES13241

Soft Groin Harness - Size 1 TH6614/4

Soft Groin Harness - Size 2 TH6714/4

NEOPRENE HARNESS (Flexible)

Small TH6385

Med TH6585

A 125 190

B 210 325

C 105 110

D 90 190

E 55 100

F 225 250

Extra Small

Small

Medium

Large

Extra Small

TH6139

Small

TH6616/4

Medium

TH6617/4

Large

TH6717/4

A 185 250 265

B 235 310 335 450

C 150 185 230

D 100 160 170 235

E 115 105 120

F 200 177 215 250

OTHER HARNESS OPTIONS

Recess Headrest Extra Recess Headrest

Occipital Roll Headrest Extra Recess With Curved Sides Headrest

*If a footpad is needed, ankle cuffs can only be used with footpads with a depth of 1" or less

180mm >

180mm - 220mm 260mm <

220mm - 260mmKB8.70001.0

KB8.70001.1

KB8.70001.2

KB8.70001.3

PATIENT MEASUREMENT RECORD

Name: ___________________________________ D.O.B: ________________________

Diagnosis: ______________________________________________________________

Current Equipment: _______________________________________________________

Height: ______________________ Weight: ____________________ M / F

Date Measurements Taken: ________________

By Whom: ____________________________

Page 3 of 3

1 Top of head to seat: ________

2 Top of shoulder to seat: ________

3 Under armpit to seat: ________ (Axilla Height)

4 Actual sitting depth: ________

5 Shoulder width: ________

6 Chest Width: ________ (Arm Pit to Arm Pit)

7 Hip width: ________

8 Left leg drop: ________

9 Right leg drop: ________

Please state actual client measurements in mm.

Any Additional Information / Sketches: