Non-occupied Adaptive Equipment Study

Adapy Smart Mobility User Experience Study

Study Participation Instructions:

Thank you for your interest in participating in the Adapy Smart Mobility System study! We’re looking for 5 individuals who currently use adaptive equipment in their vehicle such as a crane, lift or transfer seat (such as the Asento XL or Evo) to help us test and improve our innovative wireless control system.

This study focuses on evaluating the user experience with Adapy’s mobile app interface and wireless functionality as well as the new Pathways Platform—(This is equipment only-not human testing). Participants will receive the Adapy Smart Mobility System as part of the study, installation will be coordinated through your mobility dealer and fee's may apply for installation.

In return, we ask that you provide feedback via surverys as well as a short video testimonial about your experience. Please complete the form below to help us determine your eligibility.

Learn More About Adapy by visting: https://www.adapy.com

Enter your email address

Enter your first name

Enter your last name

Are you a U.S Veteran?

Yes

If yes, what type of veteran status applies to you? (Multiple Choice)

Service-Connected Disabled Veteran

Recently Separated Veteran

Active Duty Wartime or Campaign Badge Veteran

Armed Forces Service Medal Veteran

Other

Unsure

Are you currently working with any of the following services? (Check all that apply)

Vocational Rehabilitation (State-level)

Workforce Services

Department of Veterans Affairs (VA)

Occupational Therapist

Physical Therapist

Case Manager or Social Worker

None of the above

If yes, please provide the name and contact information (if known) of your representative, therapist, or counselor:

What type of disability do you have?

Paraplegia

Quadriplegia

Amputation

Neuromuscular Disorder (e.g., MS, ALS)

Traumatic Brain Injury (TBI)

Other

Do you use a wheelchair?

Yes - Manual

Yes - Power

Which adaptive equipment do you currently use in your vehicle or mobility setup? (Check all that apply)

Bruno PUL-1100 Lift

Transfer Seat (e.g., Asento XL, Evo)

Harmar Lift

BraunAbility Equipment

Sure-Grip Driving Controls

Truck bed Topper

EZ Lock or Q'Straint Docking

Tech Access

Yes - iPhone

Yes - Android

Why are you interested in participating in this study, and how do you think Adapy could benefit you?

Enter your phone number

This study is for United States only.

We use Brevo as our marketing platform. By submitting this form you agree that the personal data you provided will be transferred to Brevo for processing in accordance with Brevo's Privacy Policy.

Consent & Opt-In Statement

Check Here

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge. I understand that Adapy, Inc. may contact me regarding my eligibility for the study, product installation, or to collect feedback related to the Adapy Smart Mobility System. I give my consent to be contacted via email, phone, or text message for purposes related to this study or future updates about adaptive mobility solutions. I understand that my participation is voluntary and that I may opt out at any time.