Child's Weight (lbs.)
Child's Height (in.)
Medical Diagnosis Related to Mobility Challenges: (i.e. hemiplegia)
—Please choose an option—YesNoDoes your child currently receive physical therapy for mobility related issues?
—Please choose an option—YesNoIs your child able to sit unassisted?
—Please choose an option—YesNoDoes your child have the ability to crawl?
—Please choose an option—YesNoDoes your child currently use any other devices to assist with mobility?
Medical Devices Used:
(i.e. Oxygen, Feeding, etc.)
Please tell us about how you came to discover Bella's Bumbas.
—Please choose an option—YesNoSmall basket for portable medical devices.
—Please choose an option—YesNoKris Kart for portable ventalator.
—Please choose an option—NoRightLeftR/L hand drive available for children unable to self-propel using both hands.
—Please choose an option—YesNoChildren over 33 in. tall we offer an OPTIONAL 5 in. base extension for $15.00.
Which style chair from the picture below will work best? —Please choose an option—1. Soft Bumbo2. Ingenuity3. High Back4. Kenzie