Do you use a manual wheelchair? *
Yes      No

Brand of manual wheelchair *

Brand of current wheel *

Current wheel size and type *

Would you like to schedule a test drive?
Yes      No

I am interested for: Myself       Friend

MagicWheels are not recommended for bariatric applications (over 250 pounds).
Do you meet this guideline?
Yes      No

What type of insurance do you have?

(Optional) Please tell us about your level of injury or other reason for using a manual wheelchair and how you think MagicWheels will help you (250 words or less). This will let us verify our wheels will suit your needs.

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