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Client Form & Payment - Gold Package

Please check yes or no to following questions:

Do you have soreness or discomfort in the wrist/forearm/elbow?
Is there soreness or discomfort in the shoulder?
Is there soreness or discomfort along the neck/shoulder region?
Is there soreness or discomfort in the low back?
Do your eyes become sore/tired at the end of the day?
Do you experience headaches related to prolonged screen use?

Four photos and 1 optional photo: Have someone take photographs of you using a digital camera or phone camera. Take a picture at 4 different angles while the client is sitting at the workstation/desk.

**Photos should be discreet and obstruct any private or company information.

 Full body View from the Right, Portrait Orientation
 Full body View from the Back, Horizontal/Landscape Orientation
 Full body View from the Left, Portrait Orientation
 Full body View from overhead, Horizontal/Landscape Orientation
 Optional photo of bottom of chair showing wheels
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