Doggon' Wheels - Wheelchairs for pets, pet wheelchairs, dog carts, mobility aids for pets

PART I - INFORMATION & MEASUREMENTS
This form will take personal information about you and your pet.
When completed, click the Continue button at the bottom to continue with your order.
Part II will collect your selection of items for purchase.
Your Credit Card Information will be collected through a secured server.

ABOUT YOU Please fill in all fields so we can contact you should we need more information. Fields with an * are required. NOTE: Your name is what your order will be filed under. This name should be of the person most likely to contact us with questions regarding the order. Please reference this name so that we may locate your file quickly.
*Contact 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, etc.)
Are Pet's Front Legs Strong?	Yes No	Does Pet Have Any Use of Back Legs?	Yes No
Are you interested in 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 ordering a wheelchair, quad chair, front-end extensions or support slings, you MUST send the measurements needed for YOUR pet! Click HERE for the Measurements Chart. Click HERE for measurement taking photos.
1. Top of Hips to Floor		2. Top of Shoulders to Floor
3. Hips to Shoulders		4. *Girth of Chest Behind Legs
5. *Girth of Upper Thigh		6. Width Across Hips
7. Width Across Shoulders		8. *Girth of Abdomen
9. *Girth of Upper Front Leg		10. *Width Between Arm Pits
* Only 4, 5, 8, 9 and 10 are needed for Support Slings Please send all measurements Quad Chairs, Front Extensions and Wheelchairs

I have read and agree to the Refund and Returns Policy* (Shipping is non-refundable) Indicate YES by Checking Box

We ship using UPS Ground. Call or email for other options.

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Doggon' Wheels ~ 115 Commercial Drive, Unit A - Bozeman, MT 59715
1-888-736-4466 (406-522-1510) ~ fax 1-888-236-4329 (406-522-0188) ~ doggon@doggon.com