Begin with structured intake, not guesswork.

01

Case Type

Case Type Select one Walking / movement difficulty Sitting / posture problem Bathroom safety / toileting issue Transfer / caregiver difficulty Therapy / recovery support Not sure

02

Support Details

Who needs support? Select one Adult Child / pediatric Elderly person Post-surgery recovery Neurological condition Caregiver-supported user

03

Functional Status

Can sit independently? Select one Yes No With support Not sure Can stand with support? Select one Yes No Sometimes Not sure Can walk with support? Select one Yes No Short distance only Not sure Needs caregiver assistance? Select one Yes No Sometimes Not sure

03A

Optional Measurements

04

Daily Concerns

Care level Select one Independent Independent with supervision Caregiver-assisted Requires professional assessment before use Not sure Urgency Select one Immediate / unsafe now Within few days General guidance

05

Current Equipment

Current Equipment Select one None Walker Wheelchair Commode chair Shower chair Other

06

Environment

Environment Select one Home Clinic School Hospital Bathroom layout issue Stairs issue

07

Daily Concerns

Safety Concerns Select one Falls Pain Poor posture Unsafe transfer Pressure sore risk Caregiver strain

08

Functional Difficulty

Optional — describe only if you can. RehabMart can still review your case with basic details.

Functional difficulty

Your information helps RehabMart identify whether the case needs a ready product, configured setup, or assessment-required solution.

09

Environment

Environment Select one Home bedroom Home bathroom Indoor mobility area Outdoor/community mobility Clinic or rehabilitation center School or care facility

10

Optional Upload

Optional image upload

Photos or short videos may help RehabMart understand the case, but recommendations still depend on review.

11

User Details

Name Age Approx weight City Select city Islamabad Rawalpindi Lahore Karachi Peshawar Quetta Other Phone / WhatsApp Email Preferred Contact Method WhatsApp Phone Call Email