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LiftSeat Online Product Registration

Please register your LiftSeat product by completing this online form to ensure proper warranty coverage. If you prefer, you may also register your LiftSeat by completing the form in the Owner's Manual.

Name *

Address *

City *

State *

Zip Code *

Email Address *

Phone Number *

LiftSeat Model Name/Number *

Serial Number *

Purchased From *

Direct

Authorized Dealer

Date of Purchase *

Month

Day

Year

Method of Purchase *

Medicaid

Insurance

Other

This product was purchased for use by... *

Self

Parent

Spouse

Other

This product was purchased for use at... *

Home

Facility

Other

I purchased a LiftSeat product because of... *

Benefits

Features

Price

Please explain:

Who referred you to LiftSeat products?

Doctor

Therapist

Friend

Relative

Dealer/Provider

No Referral

What additional features, if any, would you like to see on this product?

Would you like information sent to you about other LiftSeat products that may be available for a particular medical condition?

Yes

If yes, please list any condition(s) here and we will send you information by email and/or mail about any available LiftSeat products that may help treat, care for or manage such condition(s):

Would you like to receive updated information via email or regular mail about LiftSeat home medical products sold by LiftSeat Dealers?

Yes

What additional information would you like to see on the LiftSeat Web site?

Would you be willing to participate in future online surveys for LiftSeat products?

Yes

User's Age:

Under 50

50-65

65-75

75+

Home
Why LiftSeat?
Our Products
Who We Help
Our Company