Form

The answers you provide here are the basic information needed to begin the haute couture process. After we receive the form, we will have a more detailed interview with you, and then we will provide you with a final design and price.
*required

The type of clothing you want to make

Innerwear

Shirt

Outerwear

Other

Supplementary answer to (1)

Preferred color

Where and how often to wear it

Select

Where and when we spend our daily lives

Select

Name of injury or illness

Level of support and care required

Select

Pipe passage part

If you have a catheter, shunt, or other tube running through your body, please tell us the part of your body that is affected.

Dresser

If you need assistance with changing clothes (i.e., someone to help you undress), please tell us who the helper is.

Select

Where there should be "room" in a "wear it over your head" jacket.

When you put on or take off a "wear it over your head" jacket (non-front-opening clothes such as T-shirts, sweaters, etc.), please select the part of the clothes that you think would make it easier to put on or take off.
Please click or tap the appropriate area *Multiple answers are possible

The degree of inconvenience of a "wear it over your head" jacket

How inconvenient is it for the wearer to put on and take off a "wear it over your head" jacket upper garments (clothes that do not open in front, such as T-shirts and sweaters)?

Select

Details of the inconvenience of a "wear it over your head" jacket
※ If you answered "very inconvenient" or "somewhat inconvenient" to the previous question

Please tell us the most inconvenient actions you take when putting on and taking off a "wear it over your head" jacket. ※ Multiple answers are acceptable.

Put your clothes on your lap

Grab a hold of a clothesline

Thread the cuffs of your clothes

Put your arms through the sleeves of your clothes

Put your hands through the sleeves of your clothes

Lift one's collar with one's hands

Put your neck through the collar

Arrange one's clothes

If you have any additional explanation, please fill in the form.

Please let us know if there are any other inconveniences in putting on and taking off a "wear it over your head" jacket. Multiple answers are acceptable.

Button

Can you fasten the buttons by yourself?

Select

Button alternative

Which is your most preferred alternative to buttons?

Select

How to wear clothes "from the bottom up"

Do you ever wear clothes "from the bottom up," as in this video?

Select

Body measurements

※ If the size is 32.4cm, please enter 32.4.

Around the neck

Shoulder width

Length of a sleeve

Chest measurement

Girth of the abdomen

Around the wrist

Dress length

The length of the "clothes" you want to wear.

Number

Select

Your contact information

Agree (please check the privacy policy regarding the handling of personal information)

Finally, if you have any requests, please let us know.

Material requirements

Length requirements

How much room do you want?

What is your preference for delivery time?

Form

The type of clothing you want to make

Supplementary answer to (1)

Preferred color

Where and how often to wear it

Where and when we spend our daily lives

Areas of pain or restriction of movement

Name of injury or illness

Level of support and care required

Pipe passage part

Dresser

Where there should be "room" in a "wear it over your head" jacket.

The degree of inconvenience of a "wear it over your head" jacket

Details of the inconvenience of a "wear it over your head" jacket※ If you answered "very inconvenient" or "somewhat inconvenient" to the previous question

Button

Button alternative

How to wear clothes "from the bottom up"

Body measurements

Number

Your contact information

Finally, if you have any requests, please let us know.

Details of the inconvenience of a "wear it over your head" jacket
※ If you answered "very inconvenient" or "somewhat inconvenient" to the previous question