Easy-Up Purchase Form

Easy-Up Order

At Wheeleo®, we highly value feedback from healthcare professionals and patients. We plan to introduce the Easy-Up device in Belgium and want to jointly assess its true potential.

If you have the opportunity to test it and believe it could meet a specific need (for you, your patients, or your facility), we invite you to complete this form.
This is by no means a purchase commitment, but simply an exploratory survey.

Your detailed feedback will be valuable for:

identifying clinical or domestic situations where the Easy-Up provides a real benefit,
understanding its usefulness in daily practice,
deciding if it deserves to be more widely distributed in Belgium.

Thank you in advance for sharing feedback as comprehensive as possible to help us make the right decision.

I'm a :

Company / Institution / Establishment

Enter "NA" (not applicable) if you do not belong to a company/institution/establishment.

Identity

First Name

Last Name

Phone

Address (Street, Number)

Postal code

City

Country

Email / us

How many Easy-up would you like to order?

Give us your feedback!

Could you provide us with comprehensive feedback on the test? How did you find this device? What are the advantages? Is there another product on the market that does the same thing? What is its potential for use among your patient base?

Easy-Up Order

Thank you for your interest in the Wheeleo®!

Thank you for your interest in the Wheeleo®!

Thank you for your interest in the Wheeleo®!

Thank you for your interest in the Wheeleo®!

Thank you for your interest in the Wheeleo®!

Thank you for your interest in the Wheeleo®!

Thank you for your interest in the Wheeleo®!

Test the Wheeleo®