Diabetic Alert Dog Application
Welcome to MD Dogs' Diabetic Alert Dog Application. Our priority is to find an individual who will be the best match for each dog in all aspects such as activity, lifestyle, career, etc. This application is just one step of many in our matching process. If you have any questions about this application or the process, feel free to contact us at mddogsinc@gmail.com. We look forward to reading your application!
THE BASICS
Applicant name
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First Name
Last Name
Parent or guardian name (if applicable)
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address of applicant
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Applicant birthdate
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-
Month
-
Day
Year
Date
Please list the full legal name, age, relationship, and career/student to applicant of everyone who lives in the home. (E.g. John Doe, 57, Father, Construction worker)
*
Are there any other individuals with diabetes (or glucose related conditions) in the home? If so, please explain
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Does anyone in the household smoke (cigarettes or otherwise)?
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Yes
No
Are there any animals in the home? If so, please list each animal's info: name, species or breed, and age. (e.g. Sally, Rat, 2 years)
*
YOUR DIABETES
Applicant's diagnosis date (Minimum of 1 year since diagnosis)
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-
Month
-
Day
Year
Date
Date of last A1c (approximate is fine)
*
-
Month
-
Day
Year
Date
Result of last A1c
*
Goal A1c
*
Please list the any additional medical conditions the applicant has. (e.g. Anxiety, celiac disease, thyroid disease. This is critical because some conditions affect the dogs' abilities to alert)
Would you like the dog to be trained for any tasks in addition to diabetes alert? If so, please explain. (e.g. hearing alert, allergen detection, etc)
Which condition affects the applicant?
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Type 1 diabetes
Type 2 diabetes
Reactive hypoglycemia
LADA
Other
How often is the applicant's blood sugar checked each day with a glucometer? (Not a CGM)
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0 times/day (we rely on CGM)
1-2 times/day
3-4 times/day
5-6 times/day
>6 times/day
How is the applicant's blood sugar managed currently? (select all that apply)
*
Manual injections
Pump
Glucometer (finger pricks)
CGM - Dexcom
CGM - Libre
Closed loop system
If you utilize a CGM, we may ask for the last month's of data to better understand your BG ranges and fluctuations to ensure one of our DADs is the right fit. Are you comfortable with this?
Yes
No
Are you looking for a DAD to alert to lows or highs? (Select all that apply)
*
Lows
Highs
What low blood sugar threshold would you like the dog to alert to? (We recommend a level that is safe enough to treat before symptoms, but doesn't regularly occur more than 3 times/day. We will discuss this in more detail if you are a match, so this is not a commitment!)
*
A DAD requires frequent finger pricking and testing with a glucometer during the day to validate the dog's alerts. Is the applicant comfortable with this and have enough test strips for up to 10 blood sugar checks/day?
*
Yes
No
What brand of glucometer do you use?
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OneTouch
Freestyle
ContourNext
AccuChek
Other
YOUR IDEAL DOG
While DADs go through extensive training and know a wide variety of cues and behaviors, they each still have their own personalities and energy levels. What kind of energy levels are you open to? (Select all that you'd consider)
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Low energy (we almost never have these, as these are not suited to be DADs)
Medium energy
High energy
What breed of dog are you open to? (Select all that you'd consider. If you do not select a breed, you will not be contacted when we have one available)
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English Cocker Spaniel
English Springer Spaniel
Miniature American Shepherd
Anything!
Other
Would you prefer a dog from a breeder or who was rescued?
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Breeder
Rescued
Doesn't matter to me!
What type of public access training are you open to your dog being prepared for? (Select all that you'd consider)
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Only in-home
In-home + travel
Full public access to alert anywhere I am
Not sure yet
What level of training are you looking for (Select all that you'd consider. Visit our website to learn more about the descriptions of each https://www.mddogs.org/trained-dogs.html)
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Fully trained ($22,000)
Started ($15,000)
Limited Access ($12,500-$15,000)
In-Home Only ($10,000)
Will you require a DAD who can travel on airplanes? This is something that not all dogs enjoy and is case by case. We will test most dogs on this before they are placed, but we cannot predict whether a puppy will be comfortable as an adult.
Yes
No
It'd be nice, but it's not a requirement
Are you willing and able to travel to Lexington, Kentucky 3 times for transition training? (Transition training will also occur in your home, but the first few sessions are in Kentucky)
*
Yes
No
Do you have a dog proof fenced in yard? (Not a requirement but helps us get to know the environment)
*
Yes
No
Our dogs are not hypoallergenic; does anyone in the household have dog allergies?
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Yes
No
Does anyone in the household have experience training dogs? If so please list who and what experience (trained a pet, attended training classes, etc).
*
Does the applicant attend school or work? If so, please provide details and if the dog would be expected to attend.
*
(Example: Johnny attends 6th grade at a large public school and would like his DAD to accompany him. OR Alex works as a bankteller from 8-4:30 and the dog does not need to attend)
How many hours per day would the Diabetic Alert Dog be left at home?
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0-2
3-4
>5
What activities does the applicant participate in? Would the dog be expected to attend these activities to alert?
*
How active of a lifestyle does the applicant live?
*
Movies on the couch are ideal!
1
2
3
4
Almost always on the go!
5
1 is Movies on the couch are ideal!, 5 is Almost always on the go!
DADs require daily training to keep their skills sharp. Are you willing to set apart at least 30 minutes of dedicated training each day for a DAD?
*
Yes
No
Service dogs, while highly trained, are still dogs who need exercise! How do you plan on exercising your dog? (Walking, running, fetch, treadmill, biking, etc.)
*
Do you have interest in participating in dog activities/sports? If so, which sound enjoyable to you (agility, barn hunt, dock diving, frisbee, etc.) Or do you prefer to have a DAD that doesn't require additional activities and blends into your existing routine?
THE PRACTICAL SIDE
MD Dogs trained Diabetic Alert Dogs have fees between $10,000-$22,000, depending on their level of training. Many families choose to fundraise within their community toward this goal so they need 6-12 months of lead time before having a DAD placed with them. Will you need time to fundraise (and if so, how much time?) or are you able to provide the fees whenever a DAD is ready?
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MD Dogs trained Diabetic Alert Dogs have fees between $10,000-$22,000, depending on their level of training. Many families choose to fundraise within their community toward this goal so they need 6-12 months of lead time before having a DAD placed with them. Will you need time to fundraise or are you able to provide the fees whenever a DAD is ready?
We would like time to fundraise before having a dog ready for us
We will not be fundraising, a dog can be placed with us anytime
Other
In a perfect world, when would you receive a DAD? (This should also be based on the time needed for fundraising, if required. Fundraising the entire amount can be a big task and is equivalent to it's own job. Please select based on the time you anticipate fundraising to take.)
*
Tomorrow!
In the next 3 months
3-6 months
6-12 months
1-2 years
> 2 years
Are you willing and able to accept the continual financial obligations of a Service Dog - approximately $2,000/year? (insurance, vet bills, leashes, vests, private trainer, etc.)
*
Yes
No
Have you ever had a service dog, emotional support dog, comfort dog, etc. before? If so, please explain
*
Have you applied for other DADs before? Please explain. (We encourage you to continue applying for others even after submitting this application!)
*
Have you completed MD Dogs' required online course about our Diabetic Alert Dogs? It's free and the link is here: https://mddogs.thinkific.com/enroll/480887?price_id=505273
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Yes
Not yet - but will do!
Are you and all household members willing to treat the dog as a working dog rather than a pet? (e.g. follow strict rules regarding the handling of the dog - such as only the applicant feeds the dog, no excessive play by other family members, etc.)
*
Yes
No
We will do our best to train for night alerts, but not every dog is capable of them and it depends greatly on the dog's schedule and new environment. Do you understand that night alerts can never be guaranteed?
*
Yes
No
If you have a Diabetic Alert Dog in public, your diabetes will never be invisible. You will receive countless comments - good and bad - and it's remarkably similar to having a toddler with you, requiring more attention and supplies no matter the circumstances. If you plan to have a full public access Diabetic Alert Dog, are you comfortable with this attention and the burden of bringing a dog in public?
*
Yes
No
Not applicable - looking for in-home only!
Have you researched Diabetic Alert Dogs and what they do? If so, how much have you researched them?
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Just starting to learn! So still figuring out if I want one
Just starting to learn! But I know I want one!
A little - have read some news articles on them, etc.
Quite a bit - joined some facebook groups, found a forum, etc.
A lot - joined lots of groups, talked to those that have a DAD, etc.
What are your goals in having a DAD? Feel free to add any other information we haven't asked you about that you'd like us to know!
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Please share a link to one of your social media accounts so we can connect! (Facebook or Instagram). Feel free to also write "I don't have any" or "I'd prefer not to" Our facebook is M.D. Dogs Inc and our Instagram with current dog updates is @mddogs.libby
*
Is there a current dog in training that you are particularly interested in, or caused you to apply? Please list the dog name(s)
*
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