3 Are you a wheelchair user? Never Yes only occasionally – Yes most days – Yes - only outdoors Permanently If please go straight to Question 12 below. “never” Otherwise please complete questions 4 to 10 4 Does your wheelchair carry any life support equipment? No Yes including oxygen – Yes not including oxygen – 5 Are you able to move around indoors without your chair? Yes with other mobility aid(s) – Sometimes Usually No 6 Is your usual wheelchair Manual (propelled by you) Manual (pushed by a helper) A powered chair A powered scooter
3 Are you a wheelchair user? Never Yes – only occasionally Yes – most days Yes - only outdoors Permanently If “never” please go straight to Question 12 below. Otherwise please complete questions 4 to 10 4 Does your wheelchair carry any life support equipment? No Yes – including oxygen Yes – not including oxygen 5 Are you able to move around indoors without your chair? Yes – with other mobility aid(s) Sometimes Usually No 6 Is your usual wheelchair Manual (propelled by you) Manual (pushed by a helper) A powered chair A powered scooter