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Child's details

Child's name

Weight

Height

Age

A - Hip Width

B - Upper leg length

C - Top of the shoulder

D - Top of the head

Current clinical condition

Does the child have head control and good sitting balance?

Why are you looking for a new car seat? Tell us the issues with the current car seat.

What options/acessories the child needs? * Required

5-point harness

Pad to cover the buckle of the 5-point harness

Swivel base to facilitate transfers

Thoracic Supports

Tilt-in-space/recline backrest - Children with poor sitting balance

Pommel/Abduction block

Padded tray

Footrest w/ or w/o footstraps

Rear-facing car seat for children under 36 Kg

Forward-facing car seat

Your vehicle

Make/Model of the vehicle

Does the vehicle have ISOFIX? *

Yes

No

I don't know

Do you have a vehicle from Motability? Or are you applying for one? *

Yes

No

Where the car seat will be installed? Please see the picture. *

Left seat - A

Right seat - B

Your details

Full name

Mobile Number

Email

Full address

County

Post Code

Country

COMPARE OUR CAR SEATS

EXCLUSIVE DISTRIBUTOR IN THE UK

Company Registration: 10925571

VAT Registration: GB 277822761

United Kingdom

(+44) 075 345 775 83

info@lazarehab.com

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