Are you a Customer or a Dealer *—Please choose an option—CustomerDealer
First and Last Name*
Name of person completing form*
Address Line 2
Country*—Please choose an option—CanadaUSA
Province *—Please choose an option—BCABSKMBONQCNBPENLNSYTNTNU
State *—Please choose an option—ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENHNJNMNYNCNDNVOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Dealer Street Address*
Dealer Address Line 2
Dealer Country*—Please choose an option—CanadaUSA
Contact and Shipping
Who do you want us to contact?*—Please choose an option—DealerCustomerBoth Dealer and Customer
Who do you want us to ship to?*—Please choose an option—DealerCustomer
Customer Contact (Store Customer)
Customer Contact information
Serial Number* (Located under the seat of your chair)
Place of purchase* (Include dealer name and location)
Date of purchase*
To help us identify your issue, please tell us as much as possible about the problem you are having with your LIFEFORM® chair/product. Please take pictures or video of the problem you are experiencing. We require a photo(s) showing the problem close enough to see the details and another photo of the full chair. If you are reporting a noise, please make sure you do an audio/video recording. We also require a copy of your original bill of sale and the serial number to activate your warranty.
You may upload your images and documents via this link. This link does not accept video/audio files. (Please see below for instructions on how to upload those files.)
NOTE: Uploads via this form CAN NOT EXCEED 25MB. If you have more photos you need to send please email them to and reference your name and serial number.
Unfortunately, our link does not accept Video or Audio files. You have several options on how to send us these files. In all cases please ensure you reference your name and serial number.
You may email firstname.lastname@example.org with a private link to a storage platform like Dropbox or iCloud.
You may use the FREE platform wetransfer.com to transfer your files.
You may upload your files to YouTube, but please ensure the video is private and send us a link in your claim form.