Intake-Form

2. Veterinary Information

Referring Vet Name Clinic Name Clinic Email Phone Number

3. Tell us about the pet

Pet's Name*

Species*
Dog Cat Other

Age or Date of Birth*

Weight*

Affected Limb*
Which side is injured?

Left hind Right hind Left front Right front

Breed*

Sex*
Male Male Castrated Female Female Spayed

Goals of Orthotic / Prosthetic Solution

Diagnosis*
If a diagnosis is tentative or unavailable, please describe the injury location and symptoms.

Additional Information That Would Be Helpful for Our Specialist
Tell us about the unique needs of the pet!

4. Pet Parent Information
Name* Phone* Email*
Vet Clinic Shipping Address*

Please provide a good physical mailing address — this is where we will ship the impression kit.
Street*

City/Suburb*

State*

Zip/Post Code*

Country*

5. Upload Media

Please upload up to 3 photos or videos of your pet walking to help us better assess your pet's condition.

Supported formats: JPG, PNG, MP4, MOV. Max file size: 1GB. Max files: 3.

Warning: Total file size exceeds 1GB limit. Please remove some files.

6. Review your information

Name:

Email:

Device:

Pet:

Affected side:
Impression kit:
Shipping address:

Subtotal:

Terms and conditions

All custom device sales are final and non-refundable.

Any refunds issued will have the original payment processing fees deducted. These fees are non-refundable and will not be returned to the customer.

If your pet's condition changes, we can issue a refund if the device has not been fabricated yet.

We offer one complementary adjustment for the device within the 60 days fit guarantee period.

You agree to pay return shipping for the fiberglass impression, all shipping costs for future adjustments and refurbishments after the one complimentary adjustment within 60 days.

Your pet's results may vary. Rehab therapies and regular follow-up with your vet professional are recommended.

Referal or direct purchase from veterinarian required as this is a medical device.

I agree to the custom device terms and conditions*

Device Type*

Color Select

Backup Color

Do you need an impression kit?*

Would you like our team to handle impressions
in person at our Palm Harbor, FL location?

2. Veterinary Information

3. Tell us about the pet

4. Pet Parent Information

Vet Clinic Shipping Address*

5. Upload Media

6. Review your information

Terms and conditions

Empower Your Pet’s Mobility with OrthoPaws

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Drawer Title

Device Type*

Color Select

Backup Color

Do you need an impression kit?*

Would you like our team to handle impressions in person at our Palm Harbor, FL location?

2. Veterinary Information

3. Tell us about the pet

4. Pet Parent Information

Vet Clinic Shipping Address*

5. Upload Media

6. Review your information

Terms and conditions

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Would you like our team to handle impressions
in person at our Palm Harbor, FL location?