Life After SCI DVD Request

Clinicians, If your newly injured clients are not ready to watch these videos in rehab, we encourage you to give them copies to watch at home. Feel free to reorder as needed (a reorder form is included with each DVD).

To receive your free "Life After SCI" DVD, Please fill out all information that applies to you. Thank you.

I am a:
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Full Name:
Title/Diagnosis:
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	Send me the monthly "Standing Room Only" Newsletter View Sample Newsletter

Clinicians, How many dedicated SCI beds does your facility have?

Clinicians, Do you prescribe a stander for your clients after they leave rehab?

Clinicians, What stander(s) do you prescribe or use in your facility?


Please send Free "Life After SCI" DVD
	Quantity:
	1 (we will send endusers 1 video)
	5
	10
	Other

	Please send more information:
	Standing Technology Catalog
	DVD - Complete Standing Series Video
	Funding Guide to Standing Technology (Condensed Version)
	U.S. Retail Pricebook and Order Forms
	Benefits of Standing Poster (great for clinicians)

	Please contact me regarding a free demonstration of an EasyStand product.
	Any other comments or questions?


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