1300 04 05 06
sales@crescenthealthcare.com.au
crescenthealthcare.com.au
26 Metrolink Circuit, Campbellfield, VIC, 3061
Pressure Care Seat Prescription Form
Seat Material
Seat Type
Special antimicrobial multi-stretch material
H - Left Opening Dimension (mm)
G - Located from Rear of Seat (mm)
I - Right Opening Dimension (mm)
J - Located from Rear of Seat (mm)
H - Left Indent Opening (mm)
G - Location from Rear of Seat (mm)
I - Right Indent Opening (mm)
J - Location from Rear of Seat (mm)
Rear
Left
Front
Right
A - Seat Width (mm)
B - Seat Depth (mm)
C - Aperture Depth (mm)
D - Aperture Width (mm)
E - Aperture Position from rear
F - Aperture Front
Opening Width (mm)
(Not applicable on closed front
seats)
Seat Thickness if Different from
Standard of 50mm
Open Front
Closed Front
Left Side Opening
Right Side Opening
Left Side Indent
Right Side Indent
Std.
Std.
Std.
Std.
1.
Additional Foam Required (mm)
2.
Additional Foam Required (mm)
3.
Additional Foam Required (mm)
4.
Additional Foam Required (mm)
No change
No change
No change
No change
+20mm
+20mm
+20mm
+20mm
Ramp Seat Specifications - if applicable
Standard Seat Thickness is 30mm. Please mark what section from 1-4 you would like ramped.
Prescriber name :
Date:
Signature :
I can confirm that all dimensions and details included on this form are correct. Measurements are subject to a
10-15mm variance due to foam and covering variances.
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