EZ-ACCESS Ramp Worksheet

This sheet is provided for your convenience in helping you and your dealer in selecting  the correct ramp for your needs.  Please print this worksheet, fill out as complete as you can, and take it with you to your local dealer.  If you need assistance in filling out this form, contact one of our dealers.   A local dealer can be found on our dealer search page.   If you cannot find a dealer on this listing, you can fill out our inquiry form and we will be happy to send you a list for your area.   If you are purchasing a ramp for stairs that are awkwardly staggered, please have all dimensions available.

What is the PRIMARY use for this ramp: (Home/Vehicle/Other)_______________________________________
Will the ramp be moved often or left down in one location? ___________________________________________
Is the ramp going to be used with a scooter or with a wheelchair? _____________________________________
How much ground clearance do you have? (Measure distance from the battery pack or foot rests to the floor) ___________
What is the weight of the chair with and without the occupant? _______________________________________

FOR USE WITH STAIRS:
If you are planning on using the ramp for stairs, are they uniform steps (1)  or staggered (2)?  (See picture)   

What is the height _____________  and depth of each step?   ______________________________________
Are there any landings (similar to picture 2)? What is the depth? ____________________________________
How much room do you have after the last (bottom) step? (ie; length of walkway) _______________________

FOR VAN/AUTO USE:
For van use, will you be loading through the side or back of the vehicle? ______________________________
What is the distance from the floor of the van/trunk of the car to the ground?___________________________
Will the occupant be riding the wheelchair into the vehicle?  ________________________________________
What is the width of the door opening? _________________________________________________________
How much room do you have to store the ramp in the vehicle? ______________________________________

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FOR DEALER USE ONLY:

Homecare Products is the manufacturer of the EZ-ACCESS line of portable wheelchair ramps. Each ramp is designed to meet a variety of needs ranging from van access to steps and curbs. EZ-ACCESS Ramps are available in the following styles and lengths:

Suitcase Ramps	2', 3', 4', 5' and 6'	Trifold Ramps	5', 6', 7', 8' and 10'
Pathway Ramps	3', 4', 5', 6', 7', 8', 9', 10'	Rollup Ramps	3', 5' and 8'
Threshold Ramps	1", 1.5", 2" and 3"	Track Ramps	5', 7' and 10'

For further dealer information, please contact Homecare Products at 800.451.1903