Provide Case Worker's or Contact Person's name and their phone number below who has permission to speak with My Service Dog's Place on handlers behalf concerning handlers service dog and the date that handler will be or have been released from medical care.

ALL STATEMENTS BELOW ARE STILL IN EFFECT  

• My Service Dog's Place has the handlers permission to contact and utilize any veterinarian and their veterinary care/medical services that they deem necessary for the safety and wellbeing of my service dog.

• My Service Dog's Place is taking care of/pet setting the handlers service dog at no cost to them while they get the medical attention they need. Due to this, the service dog must be picked up by the handler or by someone on their behalf within 48 hours of the end date provided above unless the handler, or their Case Worker/Contact Person makes a request to extend the end date due to handlers medical care being extended. Additionally, if the end date needs to be extended, it must be requested by phone by calling MSDP at 813-997-4050 or 813-321-0880 ext # 5 AND by filling out request for extension date form located on our My Service Dog's Place program page on our website at:      www.mywarriorsplace.org/msdp  

Additionally, if the handler fails to pick up their service dog or have their service dog picked up on their behalf within 48 hours of the end date provided above or by the end date that has been extended on behalf of the handler (by phone call and by submitting an end date extention form), that it will be considered an owner surrender of the service dog and that My Service Dog's Place has  permission of the handler from the intake form to rehome the service dog.

FOR YOUR RECORDS: MAKE SURE TO PRINT FORM BEFORE YOU SUBMIT IT