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

Other (Duck, 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

Full-Limb Prosthetic

Cart

4

If you need a Cart what type?* This field is required.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* This field is required.

10" or less

11" or more

6

Are there any remaining limbs?* This field is required.

Yes

No

Deformity

7

Amputation?* This field is required.Tell us how recent your pups amputation was or if they have a deformity.

Less than 3 weeks since amputation

More than 3 weeks since amputation

It's upcoming

Deformity

8

The device is for:* This field is required.

a Front Limb

a Rear Limb

9

Shoulder or nub remaining?* This field is required.

Shoulder and nub (with elbow)

Shoulder only (scapula)

None

Shoulder and nub (no elbow)

Deformity

10

Which side is affected?* This field is required.Determined facing the back of the animal.

Left

Right

11

How old is your pet?* This field is required.

12

How much does your pet weigh?* This field is required.Use LBS

13

Please share some photos of your pet (Show affected area)* This field is required.Please show the affected area where possible. Add as many as you like. A single video is helpful too.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

14

What is your name?* This field is required.

First Name

Last Name

15

Great! What is your email address?* This field is required.

example@example.com

16

Best phone number to reach you?* This field is required.

17

Is there anything else we should know about the situation?

18

How did you hear about us?

19

Communications Permission

Yes I agree to receive communications from 3DPets