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* 1. What make and model is your wheelchair?

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* 2. Is it a manual or a powered chair?

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* 3. How did you get it?

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* 4. If other, please specify.

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* 5. What drive options were you offered?

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* 6. If other, please specify

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* 7. Do you have any of the following?

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* 8. What other adaptations do you have to your chair?

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* 9. What do you like about your chair?

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* 10. What do you dislike about your chair?

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* 11. Do you like the way that it looks?

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* 12. What do you like about the way that it looks?

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* 13. Do you like the way that it feels?

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* 14. What do you like about the way that it feels?

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* 15. What would your idea chair look like? 

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* 16. Is there anything that you would like your chair to do that it can't? Be as creative as you like.

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* 17. What other innovations would you like to see?

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* 18. Are there any accessories you would like?

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* 19. What would the perfect chair be like for you?

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