Ergonomic Assessment

Please complete the form below and we will inform you of chair options that perfectly suit your needs

Name

Phone Number

Client / Company Name

Please provide a description of any musculoskeletal disorder and any previous injuries to your spine. Also, please comment on any back pain experienced while seated and what makes that pain better or worse?

Weight (stones/kilos)

Height (feet and inches)

A. Height of lumbar above seat

B. Back of knee joint to floor

C. Back of buttock to back of knee

D. Seat surface to shoulder

E. Hip to hip

F. Shoulder width

G. Desk Height

Would you like arms on the chair?

Yes No

Desk Shape?

Rectangle Corner Round

Floor Type?

Hard (concrete/wood/vinyl) Soft (carpet)

Ergonomic Assessment

Please complete the form below and we will inform you of chair options that perfectly suit your needs

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