Request a Device

Please complete the form to request a wheelchair or prosthetic.

If you are requesting a wheelchair from multiple businesses or nonprofits, please understand that doing so may jeopardize another dog’s chance of receiving a wheelchair. To ensure fairness, please submit only one request at a time to each individual business or nonprofit.

Please note, we do not cover fees for customs or return shipping.

We are reviewing your information and will reach out to you with next steps soon. Please allow 24 to 48 hours for us to respond. Thank you for your patience!
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