Bathroom Access Assessment

Tell us a little about the person who needs bathing support and show us the bathroom. Our SolutionBased team personally reviews every submission to determine how we may be able to help.

About the Person

The person who will be using the shower chair.

First name *

Last name *

Phone *

Email *

Who should we contact?

Who is the best person for us to contact about next steps?

Person using the chair Caregiver / family member

Contact Information

Tell us who we should contact about next steps.

First name *

Last name *

Phone *

Email *

Relationship to the person *

Is bathing becoming difficult or unsafe? *

Yes No

Anything else we should know? *

Tell us anything that may help us better understand the person's bathing, transfer, mobility or caregiver needs.

Show us the bathroom *

Why we ask for photos

Every bathroom is different. Seeing the space helps our team understand the layout and determine what solutions may work. Please upload at least 1 photo (up to 10).

Helpful photos include:

•Bathroom doorway, photographed straight on
•Tub or shower showing the full opening
•Toilet and the space around it
•A wide photo showing as much of the bathroom as possible

Where is the person located? *

This helps us connect you with the right SolutionBased team member.

Search for the address

Pick a suggestion to fill the fields below, or enter them yourself.

Street address *

City *

State *

ZIP *

Add at least 1 photo of the bathroom to enable submission.