Service Dog Registration

NationalServiceAnimalinstitute.org

Service Dog Registration
Your Name *

First Name Last Name
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone *

Area Code Phone Number
Dog's Name
Dog's Breed
Have you ever been diagnosed with a disability?

Yes No
Has your dog completed basic obedience training (either by yourself or another competent person).

Yes No
Has your dog been trained (by yourself or another competent individual) to assist you in alleviating your disability?

Yes No
Please explain how your dog assists you. Please note we will NOT disclose this information to ANYONE without your permission.
Federal Law permits any individual who has a valid disability the right to have a Service Dog to assist them with their disability. You also have the right to train your own Service Dog. Using the information provided in the above evaluation our agency will determine if you are eligible for a Service Dog license and Identification card issued from the National Service Dog Institute.

If you do not qualify we will issue a full refund of your purchase price.
Please upload a picture of your Service Dog, we can crop the picture for you if necessary

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By signing you confirm the above information is true and correct

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Service Animal Registration *
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Lifettime Service Dog Registration and ID Badge $ 39.95
Full Service Registration, Service Dog ID and Service Dog Certificate

Total $ 0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

NationalServiceAnimalinstitute.org