UK and Ireland Trial Request form

Request a trial device from Smartbox UK and Ireland.

Country(Required)

United Kingdom

Ireland

Have you met with one of our Assistive Technology Specialists?(Required)

Yes

Which member of the Smartbox team have you met with?

Adam Waits

Jay Tuck

Jacqui Malthouse

Natasha Ward

Jess MacRae

Becky Fry

Shaun McCormack

Date of assessment

DD slash MM slash YYYY

Enquiry number

Your details

Name(Required)

First Last

Organisation

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Email(Required)

Phone(Required)

Delivery information

Is the delivery address different?(Required)

Yes

Delivery Name

First Last

Delivery address

Delivery address 1 Delivery address 2 Delivery city Delivery county Delivery ZIP/postcode

Delivery Email

Delivery Phone

All of our communications aids are supplied with Grid 3 installed. Our trial devices do not come with a mount unless required

Grid Pad

Our most flexible solution for people with complex access and communication needs. Our Grid Pad range has been designed in collaboration with AAC users, with a rugged design, for communication all day, every day.

Grid Pad 10s

Grid Pad 13

Grid Pad 13 with eye gaze

Grid Pad 15

Grid Pad 15 with eye gaze

Eye gaze options

If you require an eye gaze camera to access your communication aid, we offer a range of options.

Lumin-i

Vida Go

Alea

I’m not sure

Talk Pad

Talk Pad is a powerful, portable and rugged AAC device, with a 10 hour battery life and loud speaker. Available with Grid for iPad.

Talk Pad 8

Talk Pad 10

Touch Pad

Touch Pad is a lightweight, fast and and portable communication aid, with a long battery life and clear amplified sound. Powered by our flagship Grid software.

Touch Pad

Accessories and head pointers

From switches to head pointing, we offer a broad range of devices to help you interact with your communication aid and home.

Brainfingers

Joycable

Headmouse Nano

Quha Zono / Quha Zono X

Emego

Cenomy Muscle Switch

BJoy Ring

Mounting options

If you require a mount for your device, we can include a desk or floor mount as part of your Smartbox trial.

Desk stand

Floor mount

Other

Special requests

To request your trial from us, please complete the form below. We will then be in touch to confirm your booking. If you would like to know more about our trial process, please get in touch with us. Fields marked with an * are required

Acceptance of liability(Required)

I agree that the selected devices(s) and all accessories are my responsibility until returned to Smartbox and I am responsible for any costs incurred due to damage or loss. I will have the system and accessories packed in the original packing and ready to be collected by courier at the end of the trial period. I understand that I will be liable for damages that occur in transit due to inadequate packaging.

I accept the liability for the trial device(s) and accessories.

I accept that a charge may be incurred if the trial device is kept longer than the agreed period with Smartbox. The charge will be equivalent to one month's rental multiplied by the time overdue. This charge will be applied at the discretion of Smartbox.(Required)

I accept that a charge may be incurred if the trial device is kept longer than the agreed period with Smartbox. The charge will be equivalent to one month’s rental multiplied by the time overdue. This charge will be applied at the discretion of Smartbox.

I accept that late return of my trial device may incur a charge

UK and Ireland Trial Request form

We currently have high demand for trial devices; please allow two weeks for your trial request to be processed.

To request your trial from us, please complete the form below. We will then be in touch to confirm your booking. If you would like to know more about our trial process, please get in touch with us.

Your details

Delivery information

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