48
THE MOUNT
MENT
OR EV
AL
SHEET
Lets get star
ted....first we need some information:
Contact P
erson
Attach to: (Che
ck all tha
t app
ly)
Client (Optional)
Dev
ice
/ T
ray
Organization
Name
Phone #
Name/initials
Wheelchair (
Make/Model)
SGD or
AAC make/model
Phone make/model/dimensions
Prefer
to
mount
on:
How does client access their device?
Direct Select Switch Eyegaze/Head
Tracker
Power
Stroller
W
alker/Gait T
rainer
Power Standing
Tilt/Adjustable
Bed
If direct select:
Client Cha
racteristics
A
Tablet-iP
ad
Make:
See website for Device Plate Graph
BlueSky Designs 2637 27th
Ave South
Suite 209 Minneapolis, MN 55406
www
.mountnmover
.com
612-724-7002
info@
blueskydesigns.us
Manual
Title
Does Device have QRM/UDS bracket?
Laptop T
ray
12 x 16
Tray
Rotate portrait to landscape required?
Is there an existing tray on w/c?
Age
W
ith manual w/c does client apply brakes?
Include
photos
*
How does client drive P
ower Wheelchair?
(if applicable)
Hand joystick on:
Chin joystick
Head array
Diagnosis
Y
N
Light touch
N
Y
W
ill the client move it?
If yes, what arm preference?
Can they cross midline?
Right
Left
N
Y
Medium touch
Strong touch
Both
Floor Stand
Table
Preferred Mount(s)
Require access to more than one device?
Y
N
If yes:
At the same time
Change as needed
Two Mounts:
one post - (double decker)
two posts
Locking
Non-Locking (adjustable resistance)
Simple (tray on post)
Not sure
Dual
Single
Tilt’n T
urner
Dual
Single
Tilt’n T
urner
Large
Small
Y
N
Right
Left
Need help building a mounting system? P
lease complete the
following steps and return to: info@
bluesk
ydesigns.us
Step 1. Complete section
A
Step 2.
Take photos as described in section B
Step 3. P
rovide post length determined in section C
Step 4. Complete wheelchair frame information in section D
W
e will contact you with a quote.
Additional support for installation and use is available via phone, Skype, or email.
*
Right side
Left side
Do you need to remove both foot rests?
Y
N
Model:
Dimensions:
www
.mountnmover
.com
Pow!r Mount
Pow!r Shoulder
Pow!r T
ilt
If
Tobii I-13 or I-16
will the client use IR feature?
If yes, will it need to be used at the same time as the mount?
Y
N
W
ill footrests need to be
rotated or removed?
Y
N
*
*
*
required info
Summary of Contents for Mount'n Mover
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Page 41: ...Assembly Use Mount n Mover TableClamp 1 2 3 5 5 4 6 41...
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