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Request A
Free Pediatric
Belt Cane

We are dedicated to provide a free cane to as many children as possible. Free cane is available to children who become a valuable part of our research study and curriculum. Download the curriculum brief below.

CONTACT INFORMATION

 

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PREFERRED METHOD OF CONTACT
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PHOTO / VIDEO RELEASE. CHECK ALL THAT APPLY
SHIPPING ADDRESS
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SHIPPING PREFERENCE
CHILD'S INFORMATION
CHILD'S MEASUREMENTS
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Does child receive any of the following services:
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If yes, where have the mobility devices been used?
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Thanks for your order!