YOUR CONTACT INFO
Please fill in all fields so we can contact you should we need more information.
Fields with an * are required.
*Your Name:
*Email Address:
*Mailing Address:
*City, State, Zip:
*Telephone w/Area Code:
Best Time to Call:
ABOUT YOUR PET
Please give us as much information as you can about your pet.
*Pet's Name:
*Pet Breed:
*Pet's Age:
*Pet's Weight:
*Pet's Gender:
*Cause of Disability:
Date/Onset of Disability:
Pet had Spinal Surgery?
Yes No
Other Health Conditions:
Does Pet Get Regular Exercise?
Yes No
Does Pet Stay Mainly Indoors?
Yes No
Terrain Pet Plays On (lawn, sand, carpet, hardwood floors)
Are Pet's Front Legs Strong?
Yes No
Does Pet Have Any Use of Back Legs?
Yes No
Are you looking for a Refurbished Wheelchair?
Yes No
New Wheelchair if Refurbished is unavailable?
Yes No
Please use this area for additional information or requests.
If you are looking for a refurbished wheelchair, quad chair,
front-end extensions or previously tried-on support slings,
you MUST send the measurements needed for YOUR pet!
Click HERE for the Measurements Chart.
Top of Hips to Floor
Top of Shoulders to Floor
Back of front leg to back of rear leg (elbow to rump)
Girth of Chest Behind Legs
Girth of Upper Thigh
Width Across Hips
Width Across Shoulders
Girth of Abdomen
Girth of Upper Front Leg
Width Between Arm Pits
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