Handicapped Pets Foundation Wheelchair Application

Pet Wheelchair Donation Form
Thank you for your willingness to donate!

We try our very best to quickly match a donated wheelchair to a pet in need, but sometimes it takes a couple months to find the ideal match.

Additionally, to avoid additional shipping delays and to get the pet in need in their wheels sooner, we typically have donated wheels sent directly to the pet's owner, instead of sending the wheelchair to the Foundation.

Please complete the form below to donate a gently used wheelchair to a pet in need. Again, thank you!
Your Information
Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Wheelchair Information
Wheelchair Brand*
Wheelchair Type*

Rear wheelchair (for back leg support)Quad 4-wheel wheelchair (for full support)Front wheelchair (for front leg support)Other
Wheelchair Size*
Describe the condition of the wheelchair.*
Please provide a photo of the wheelchair you'd like to donate, demonstrating its current condition.*

Please note that we are unable to accept donated wheelchairs in poor condition.
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Pet Information

This information is helpful to ensure a proper match. Please complete the following information based on when you ordered the wheelchair for your pet.
Species

DogCatOther
Breed
Weight
Optional Tribute

We recognize that often wheelchairs are donated after a great loss. There is absolutely no pressure to include your pet's details below, but if you'd like us to include your pet in our list of honorees, please fill out as much of the below information as you'd like.
Pet's Name
Pet's Name
Upload a photo of your pet using the wheelchair.

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Any additional information you would like to share about your pet?
Shipping Costs*

I will cover the shipping cost.I would like the Foundation to provide me with a shipping label.
Please verify that you are human*
Should be Empty:

Pet Wheelchair Donation Form

Your Information

Wheelchair Information

Pet Information

Optional Tribute