Partner Bed Assessment Script Form

Please ensure the client’s bedroom layout is considered when confirming the sleeping side of the bed users (e.g. access to bathroom, carer access etc.).
Any two Icare bed models can be used in a partner set-up.
The client must sign the form to confirm they understand and confirm the bed layout before the manufacturing process can begin.
Please complete all information on this form before submission.
Note: When the partner set-up (two beds) are in place, there is NO gap between the mattresses

Client Name*

Suburb & Postcode*

Referrer Name*

Referrer Phone Number*

Referrer Email*

Store Name:*

Store Contact Person*

Purchase Order Number / Order Reference Number*

Referrer Signature:

Date: