Student Ergonomic Assessment Referral Form

Referrer’s Details

Name of Assessment Centre *

Referrer's Name *

Referrer's Telephone Number

Referrer's Email *

Student's Details

Student's Name *

Student's Address *

Student's Email *

Student's Telephone Number

Student's Medical Background

Equipment to be Considered During Assessment

Chair
Desk
Footrest
Laptop Stand
Mouse
Keyboard
Laptop Carry Case
Any other equipment to be considered Please State Other Equipment to be Considered

Please State Other Equipment to be Considered

GDPR Agreement *

I consent to having Online Ergonomics store my submitted information so they can respond to my inquiry, in line with their Privacy and Data Protection Policy.

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Free Shipping*

We offer free UK shipping for orders over £250.

Desk & Chair Setup

We can setup your standing desk and chair in your home.

Advice & Assessments

We offer free advice and seating assessments.

Rated Excellent

We are rated excellent by our customers

Online Ergonomics Ltd, Unit 18, Ellough Industrial Estate, Beccles, Suffolk, NR34 7TD

01502 715400

sales@online-ergonomics.co.uk

About Online Ergonomics

We work closely with medical professionals such as physiotherapists, chiropractors, osteopaths and ergonomists to keep abreast of the latest developments and advances in office furniture design. As a result, we’re confident that our products are at the cutting edge of ergonomic innovation.

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