Customer Name *

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Phone

Item in question

Date item purchased from Mike Ayres Design

General description of the issue

Provide images of the issue

Ideally provide: 1) Complete image of the item with the issue. 2) A close up of the area in question. 3) Any part which has detached and/or failed. 4) The suspension point (if required). 5) The suspension & height adjustment kit (as it is set up)

Supported format: JPG, JPEG, PNG, GIF, SVG.

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Images Provided

Complete image of the item with the issue
A close up of the area in question
Any part which has detached and/or failed
The suspension point (if required)
The suspension & height adjustment kit (as it is set up)

Tick which photos you have uploaded

Maintenance Checks

Dates and issues should be clearly marked, also with who checks, how often, any comments etc...

Has there ever been any concerns or issues recorded with this item previously?

Are all activities on this equipment supervised by a qualified SI practitioner (Module 2+) ?

If not, please give details of the level of supervision

Has the therapist/supervisor had any training on Sensory Integration Interventions

Please give the age range of the users/clients that use the equipment

Weight range of users and weight of heaviest client who uses the equipment

Is there ever more than one person on the equipment at the same time?

Please provide us with some information of the needs/ability levels of the clients

How often does this item get used?

How intensely is the equipment used?

Does the equipment make a noise? (The equipment will make some noise and this is natural given the materials).

Thank you for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thank you for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Please use this form for any Damages, Faults or Warranty queries

Thank you for getting in touch!

Thank you for getting in touch!

Vibrating Back Massager

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