Meadowbrook Hands for Hope Order Form
If you know a child in need of a 3D prosthetic hand, please fill out this form. Once we receive your information, we will be able to send you the hand. We are excited to help your child!
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What is the circumference of your/the child's wrist? *
Please use inches.
Do you need a right hand or a left hand? *
Gender
Clear selection
What style of hand? *
For more information, read about our creations on the website. For even more information on the differences, please either contact us or go to e-Nable's website at http://enablingthefuture.org/
What is your name? *
First and last, please.
What is your shipping address? *
Please tell us to where you would like us to send the hand after it is made.
What is your phone number?
In case we need to contact you easily, please inform us of your telephone number.
What is your email address?
In case we need to contact you easily, please give us your email.
How old is your child? *
Please request a color for the hand:
3D printed colors can help personalize your hand. You can pick as many colors as you want. there are three main sections of the hand: the fingers, the wrist, and the palm. Fingers can be different colors.
Which is the most convenient way for us to contact you?
What is your child's name? *
First and Last name please
What would you most like to do with your new hand? *
Please consult your child.
Required
Is there a specific use you would like the hand to be made for? A past example been a hand that can strum a guitar, etc.
How did you discover us? *
Please add any other comments or questions below.
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