Request Assessment

After we review your Request for Assessment form, we will contact you by phone to discuss further if your child is appropriate for a Trial in the MkII Hart Walker or TAOS Walker. If it is determined that your child is appropriate, a TAOS Measurement Form and MkII Hart Walker Measurement Chart (Provided by us) will need to be filled out by your child’s Physical Therapist and we will schedule your child for a trial appointment.

We strongly urge that your child’s Physical Therapist be present or that you plan to video this appointment as all Insurance Companies require a written Letter of Justification by your child’s Physical Therapist in order for them to cover this device. See our FAQ page (Frequently Asked Question’s) for further information regarding the MkII Hart Walker being covered by Insurance.

The first trial appointment is free of charge and takes about 1 ½ hours of time.

If you do not reside in the Northeast section of the United States, please visit our Resources page for contact information of other providers in the United States. Feel free to fill out the Request for Assessment, we can forward that information onto the provider in your area.

Please enter appropriate information for the individual requiring assessment below:

1. First Name(required)
2. Last Name(required)
3. Diagnosis(required)
4. Gender Male Female
5. Age(required)
6. Weight(required)
7. Height(required)
8. Parent/Guardian(required)
9. Address Line 1(required)
10. Address Line 2
11. City(required)
12. State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennslyvania Rhode Island South Carolina South Dakota Tennesseee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samao Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands ------------------------------------ Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory (required)
13. Zip/Postal Code(required)
14. Home Phone(required)
15. Work Phone
16. Email Address(valid email required)
17. Therapist Name
18. Therapist Phone
19. Best Time to Contact You
20. How did you hear about Great Strides LLC Google Printed Ad Brochure Doctor or Medical Personnel Friend or Relative Other
21. Additional Information(Please provide us with additional information, ie; surgical interventions, current orthotic devices/equipment etc.)