Common use of Other Equipment Clause in Contracts

Other Equipment. Do you currently, or have you ever owned a communication device? Do you currently own a wheelchair Ye s No Ye s No Date of Purchase: (We must have at least month & year) Make: Model: Choose device: I -12 I -15 Indi I-110 I -12 and Eye-Gaze I -15 and Eye-Gaze T7 Choose mount: Wheelchair Rolling/Floor Desk/Table Accessory: Please list * Not all insurance plans will cover multiple mounting system

Appears in 5 contracts

Samples: tdvox.web-downloads.s3.amazonaws.com, tdvox.web-downloads.s3.amazonaws.com, tdvox.web-downloads.s3.amazonaws.com

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Other Equipment. Do you currently, or have you ever owned a communication device? Yes No Date of Purchase: Do you currently own a wheelchair Ye s Yes No Ye s No Date of Purchase: (We must have at least month & year) Make: Model: Choose device: I -12 I -15 Indi SC Tablet I-110 I -12 EM-12 w/ EyeMobile Plus I-13 and Eye-Gaze I -15 I-16 and Eye-Gaze T7 Indi 7 EM-12 Choose mount: Wheelchair Rolling/Floor Desk/Table Accessory: Please list * Not all insurance plans will cover multiple mounting system

Appears in 3 contracts

Samples: download-tobiidynavox-com.s3.amazonaws.com, tdvox.web-downloads.s3.amazonaws.com, download.mytobiidynavox.com

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Other Equipment. Do you currently, or have you ever owned a communication device? Yes No Date of Purchase: Do you currently own a wheelchair Ye s Yes No Ye s No Date of Purchase: (We must have at least month & year) Make: Model: Choose device: I -12 I -15 Indi I-110 I -12 I-12 and Eye-Gaze I -15 Choose mount: I-15 I-15 and Eye-Gaze Indi I-110 T7 Choose mount: Wheelchair Rolling/Floor Desk/Table Accessory: Please list * Not all insurance plans will cover multiple mounting system

Appears in 1 contract

Samples: www.tobiidynavox.com

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