Amtryke therapeutic 2025

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4.8 out of 5

228 votes

The document is a comprehensive request and assessment form for the Amtryke Therapeutic Tricycle, designed for individuals with disabilities. It includes sections for personal information, diagnosis, financial assistance inquiries, and details about the recipient's needs. The document also outlines safety precautions, assembly instructions, and customization options for various tricycle models. Additionally, it emphasizes the importance of submitting all required forms to AMBUCS before placement consideration.

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Click ‘Get Form’ to open the Amtryke Therapeutic Tricycle Request Form in the editor.
Begin by entering the recipient’s name, mailing address, city/state/zip, diagnosis, age, date of request, phone number, and email. Ensure all fields are filled accurately for a smooth processing experience.
If the recipient is under 18, provide the parent/guardian's name and contact information. This section is crucial for consent and communication.
Indicate how you heard about the Amtryke therapeutic tricycle by checking all applicable options. This helps us understand outreach effectiveness.
Answer whether financial assistance is needed and specify how much can be paid if applicable. This information aids in assessing eligibility for support.
Provide a brief description of the recipient to assist in funding efforts. Remember to include a photo if possible, as it enhances funding opportunities.
Finally, ensure that all required signatures are obtained before submitting the form via mail, email, or fax to your local chapter or AMBUCS Resource Center.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (228 Votes)

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How do you get amtryke tricycle for my state?

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What is an AmTryke bike?

\u200b What is an Amtryke? Amtrykes are therapeutic tricycles that are designed for children and adults with disabilities. We believe every child or adult, regardless of their abilities should have the opportunity to ride their own bike. Amtrykes come in a variety of models.

What does ambucs stand for?

How do I get an Amtryke?

Call the contact person and ask for an Amtryke evaluation. They may or may not waive the co-pay for the visit. If there isn't an Evaluation site near you, take the request and waiver form, assessment form, and tryke selection form to your child's therapist or physician.