Online Assessment Form Your Name* Email Address* Telephone No. Postal Address Nature of work undertakenPC operatorCall centreWriting / DrawingOtherIf 'Other', please specifyNo. of hours worked per day If appropriate please provide a description of any musculoskeletal disorder and any previous injuries to your spine. Please comment on any back pain experienced while seated and what makes that pain better or worse?Gender Your Weight (stones/kilos) Your Height (feet & inches) A - Height of lumbar above sear (mm) (mid point) B - Back of knee joint to floor (mm) (wearing shoes) C - Back of buttock to back of knee (mm) D - Seat surface to shoulder (mm) E - Hip width (mm) (max. measurement whilst seated) F - Shoulder width (mm) G - Desk height (mm) H - Shoe heel height (usual shoes) I - Bottom of elbow to top of seat Would you like arms on the chair?YesNoWould you like a headrest on the chair?YesNoFloor type (wood, carpet, etc..) Desk shape Contact ConsentWe would like to send you details of products that we feel will suit your requirements. Please check the box below if you are happy for us to do so. Yes, send me details of suitable products
