This form will take personal information for you and your pet. Fields with an * are required. When completed, hit the Continue to Order Form button at the bottom to continue with your secured order. As an alternative to this form orders may be called in 9 am - 6 pm in Woolhampton, 0118 971 2990 or Mobile 079 177 92950, or you may fax your order (24 hours) to 0118 971 2990. Click HERE for printable Order Form in Rich Text Format (RTF)

ABOUT YOU
Please fill in all fields so we can contact you easily should we need more information. Fields with an * are required.
*Your Name:		*Email Address:
Mailing Address:		City, State, Zip:
*Telephone with Area Code:		Best Time to Call:
ABOUT YOUR PET
Please fill in 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, etc.)
Are Pet's Front Legs Strong?	Yes No	Does Pet Have Any Use of Back Legs?	Yes No
Additional information or requests, please use this area.
PET MEASUREMENTS It is essential that we have all measurements required to prepare your order for a wheelchair or saddle support sling. All measurements are in inches OR centimeters. Click HERE for Diagram If you are not ordering any of the items below you may skip this part of the form. Regular Wheelchair: Measurements #1-8 Quad Chair: ALL Measurements #1-10 Rear Saddle Support Sling: Measurements #4, 5 & 8 Front Support Sling: Measurements #4, 9 & 10
1. Top of Hips to Floor		2. Top of Shoulders to Floor
3. Hips to Shoulders		*4. Chest Girth Behind Legs
*5. Girth of Upper Thigh		6. Width Across Hips
7. Width Across Shoulders		*8. Girth of Abdomen
*9. Upper Front Leg Girth		*10. Width Between Arm Pits
*I have read and agree to the Refund and Returns Policy (Shipping is non-refundable) Indicate YES by Checking Box

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Doggon' Wheels ~ Orchard Cottage, Woolhampton, Berkshire England RG7 5ST Tel: 0118 971 2990 ~ Fax: 01189 712990 ~ Mobile: 079 177 92950 ~ teila@freegratis.net

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