We bought this stretcher to transport our daughter after complications from knee replacement surgery. It came what appeared to be 99% assembled. Installation of the foot rest needed a rubber mallet, a Phillips screwdriver, and an adjustable wrench or channel locks. We figured out how it worked and put it in our Toyota Sienna after removing the left seat.It was very sturdy and my wife easily rolled me (280 lbs.) up and down our slightly sloped driveway.We really wished it would have come with directions.