2-23 UPDATE P1 3D Pets - Onboarding Questionnaire

1
My pet's name is:* This field is required.
2
Pet Type* This field is required.
Dog
Cat
Avian (Bird)
Other (Goat, Tortoise, etc.)
3
Device Type* This field is required.If your dog has 3 legs from an amputation or birth defect we suggest selecting a prosthetic. If they have no front limbs or severe deformities, select cart. If you have any questions select 'not sure' and our team will reach out!
Full-Limb Prosthetic
Cart
Helmet
Not Sure
4
If you need a Cart what type?Are you looking for a Front or Rear Cart? If you think you need a general support cart, you may want to check out Walkin Pets.
Front
Rear
5
Measurement of your pet from the lowest part of their chest to the ground
10" or less
11" or more
6
Are there any remaining limbs?
Yes
No
Deformity
7
Amputation?* This field is required.Tell us how recent your pet's amputation was, if it's upcoming, or if they are not going to have an amputation (i.e. if they have a deformity).
Less than 3 weeks since amputation
More than 3 weeks since amputation
It's upcoming
No amputation planned
8
Reason for Amputation* This field is required.Please select the closest reason why your pet underwent an amputation.
Please Select
Please Select
Cancer
Infection
Trauma/Injury
Deformity
Other
9
The device is for:* This field is required.
A Front Limb
A Rear Limb
Other
10
Shoulder or nub remaining?* This field is required.'Nub' indicates a small remainder.
Shoulder and nub (with elbow)
Shoulder and nub (no elbow)
Shoulder only (scapula)
No remainder
Undefined deformity
11
Which side is affected?Determined facing the back of the animal.
Left
Right
12
How old is your pet?* This field is required.
Less than 1 yr
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
13
Approximately how much does your pet weigh?* This field is required.Use LBS
14
Please share some photos/videos of your pet (show affected area)* This field is required.Please show the affected area where possible. Add as many as you like. Any videos are helpful too.
Drag and drop files here
Select files to upload
Cancelof
15
What is your name?* This field is required.
First Name
Last Name
16
Great! What is your email address?* This field is required.
example@example.com
17
Best phone number to reach you?
Please enter a number
18
Communications Permission* This field is required.By selecting YES, I consent to receive marketing SMS messages from 3DPets at the number provided. Msg&data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. View our Privacy Policy and Terms of Use.
YESNO
19
Where do you take your dog to the veterinarian?Name of the Veterinary office
Practice
20
What is your veterinarian's phone number?Phone Number please
21
Vet's Name (optional)The name of the primary care Doctor for you pet
22
Vet's Email Address (optional)
23
Is there anything else we should know about your pet?Let us know anything you think would be helpful for our team to evaluate your pet's unique circumstances!
Huge
Large
Normal
Small
Ok
Ok
24
How did you hear about us?OPTIONAL
Apple
Facebook
Instagram
TikTok
Google
CBS TV
Word of Mouth
Costco
YouTube
25
Communications PermissionBy checking this box you agree to receive recurring messages from DiveDesign LLC (3DPets), Reply STOP to Opt out. Reply HELP for help. Message frequency varies. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages.
Yes I agree to receive communications from 3DPets and 3DPets may contact my veterinary team for prior records.
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