HOUSE OF HOUND — WIREFRAME SAMPLE
Not a live clinical document. Use sample information only.

EQUIPMENT DISCUSSION CHECKLIST

Item I would like to discuss: ____________________

Activities I need support with: ____________________

Current equipment and how it is used: ____________________

Questions about fit, handling and suitability: ____________________

Home layout or transport considerations: ____________________

Guidance agreed with the care team: ____________________