Place Your Order

Parents Name

Your Email

Diagnosis (inc hospital and diagnosis date)

Do you Live in the UK? If YES, Check the box and enter your address below.


Childs Name

Childs Age

Hair Type/Colour


Specific physical characteristics (eg wheelchair user, glasses etc)

Specific character, eg. Superman, Cinderella, Sporting) Or Other Character Type

Favourite Colours

Does you child have any siblings? If YES, Check the box and enter details below.