Seating Wheelchair Clinic Pre-Appointment Form - childrensmercy 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your child's diagnosis and the onset of their disability in the designated fields. This information is crucial for the clinic to understand your child's needs.
3. Next, specify the goals for your visit and mobility preferences. Indicate whether you want your child to be independent at home, school, or comfortable in their seating system.
4. Fill out the current medications and past surgical history sections. Be thorough to ensure all relevant medical information is available.
5. Describe what you like and dislike about your child's current wheelchair. This feedback helps clinicians tailor recommendations.
6. Complete the home environment section by selecting options that best describe your living situation, including accessibility features like ramps or steps.
7. Continue through transportation and school-related questions, ensuring you provide details on how your child navigates these environments.
8. Finally, review all entries for accuracy before saving or printing the completed form to bring to the appointment.

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