B Tailored - Self Assessment Form

If you are looking for a product but are unsure as to what you need, please complete the form below and a member of our team will be in touch with suitable recommendations.

Pain

Please mark the areas where you experience pain or discomfort

Head Cervical Spine/Neck Chest Stomach/Abdominal Shoulder/Upper Arm (Right) Shoulder/Upper Arm (Left) Elbow (Right) Elbow (Left) Lower Arm/Hand (Right) Lower Arm/Hand (Left) Thoracic Spine/Mid-Back Lumbar Spine/Lower Back Pelvis Coccyx Hip/Upper Leg (Right) Hip/Upper Leg (Left) Knee (Right) Knee (Left) Lower Leg/Foot (Right) Lower Leg/Foot (Left) Do you have a diagnosed medical condition?

Measurements

Next we require some measurements to find the best products for you.

Your Height Helps us tailor recommendations and options

cmft/in

Your Weight Helps us tailor recommendations and options

kgst/lbs

Details

Finally, some details so we can get in touch with our recommendations

Your Name * Your Email Address * Your Contact Number Company Name

Submit your information and one of the Bureaunomics team will be in touch with recommendations and next steps.

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