Advance Seating designs - POSE Online Form

Advance Seating designs – When sitting correctly matters

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POSE™ Online Form




We size the chair to you.

Date:	19 November 2008


Your measurements You will need to take these measurements. Click here for full instructions

Height * (without shoes):

A: * Hip joint to knee joint:		mm

B: * Knee joint to floor, wearing shoe:		mm

C: * Back of buttock to back of knee:		mm

D: * Desk height, top of desk to floor:		mm

E: * Top of shoulder (hard part) to seat surface (see diagram above):		mm

F: * Shoe heel height (usual shoes):		mm

G: Your lower back curvature:
Flat: Medium curve: Deep curve:

Foot Rest
* Do you use a foot rest? Yes: No:
If yes is it height adjustable? Yes: No:

Back Pain
How many days approximately have you had off work during the last 12 months due to back pain?		days

Medical Corset
Have you worn a medical corset at any time? (If yes, for how long?)		mths

Whiplash
Have you ever suffered from whiplash injury? (If yes, how long ago?)		mths

Backrest
Preferred height of backrest: (if appropriate)


Allergies
* Are you allergic to:
Wool? Yes: No:
Man made fabric? Yes: No:

Fabrics Standard Range (man-made fabric)

Choose fabric colour:
Extra cost options:
Pure new wool: Leather:

Floor surface?
If ‘Other’ please specify:

Please check Have you have completed all fields as appropriate? Thank you.

Personal Office Seating Evaluation

Welcome to our interactive on line POSE service. Opera chairs are “sized” to provide optimum support for a specific body shape. A chair that fits you supports the body correctly and is vital for your long term sitting comfort.

By completing this simple form, we can assess which Opera chair is right for you and advise the price. The chair is made available free on a two week sale or return basis.

CONFIDENTIAL All the information you provide is kept strictly confidential.
It is only requested to decide which chair model is most suitable for you.

For an accurate assessment please complete all sections as fully as possible, especially measurements A–F.
If you need assistance with any part of the form call 020 8747 7526.

* Your Title:

* Required fields.

* First Name:

* Last Name:

Does someone else need to have a copy of the quotation?

Their Name:

And their E-mail:

* Company Name:

Address 1:

Address 2:

Town:

County:

* Post Code:

* Telephone No:

Fax No:

* Your E-mail:

* Your Age:
(nearest)

* Your Sex:

* Your Weight:

* Job function:

Main activities?

What are your main desk activities (i.e. Computer work / telephoning):

How do you spend your time?

* Approximately how is your time split during an average day:

% computer, % writing, % telephone, % other.

Computer monitor?

If using a computer what size is your monitor?
(measure screen diagonally from corner to corner)

Is the monitor on a stand?

Desk

What is the shape of your desk?

Brief history of pain (if required)

If you need assistance with any part of the form call 020 8747 7526.

Our policy is one of continuous improvement and specifications may change from those shown. Copyright © 1998-2008 - Advance Seating designs - All rights reserved Online Privacy Policy \| Terms and Conditions \| Legal and Disclaimer notices Last updated: 11 August 2008 - Version 807. 581 - www.asd.co.uk