SPEX™ Backrest
Size: 10”x12”
Backrest Contouring Cube Chart
Record the amount of contouring cubes used. Fill out this form and enter the number of
cubes used in each pocket and save for future reference.
Clinician Name
Client Name
Date
Enter clinician name
Enter client name
Enter assessment
date.
Size of cubes = 65x80mm x 10mm thick
Enter # of
cubes
Enter # of
cubes
Enter # of
cubes
Enter # of
cubes
Enter # of
cubes
Enter # of
cubes
Left side
Enter number of
stability wedges
Right side
Enter # of
cubes
Enter # of
cubes
Enter # of
cubes
Enter # of
cubes
Enter # of
cubes
Enter # of
cubes
Enter number of
stability wedges
Notes Click here to enter text.
All Rights Reserved © Medifab Spex Seating™ Backrest contouring cube chart.
The Medifab Spex™ range is the subject of design rights and copyright. Medifab places great value in these intellectual property
rights and reserves its right to protect them if and where necessary.
www.spexseating.com