The wheelchair is an essential tool for individuals with spinal cord injury (SCI). When the capacity and fit of a wheelchair is matched to the needs and abilities of an individual with SCI, health, function, community participation, and quality of life are maximized. Throughout an individual’s life, function and health status can decline (or improve), necessitating a new wheelchair and/or seating components (eg, cushions and backrests). Additionally, a patient’s current wheelchair may be identified as a factor contributing to a health concern or functional deficit, again necessitating wheelchair adjustments. Primary care physicians often manage the complex and lifelong medical needs of individuals with SCI and play a key role in wheelchair evaluation and prescription. This article provides a broad overview of indicators that a new wheelchair is needed, describes the wheelchair prescription process, identifies important team members, reviews the major wheelchair components, and provides guidance to match components to patients’ needs and abilities.