Basic Information Form - Service Dog Program

Basic Information Form - Service Dog Program

Service Dogs Alabama
Thank you for your interest in a Service Dogs Alabama dog.

This brief form is the first step in our process. It helps us begin to get to know you and determine whether one of our dogs may be a good fit for your needs before moving forward with additional steps.

Our process includes several steps, and we want to make sure we're aligned early so you don’t spend months completing paperwork only to discover that we may not offer the type of placement you're seeking.

Completing this form does not guarantee placement and does not obligate you in any way. It simply helps us start the conversation.
Yes
If you are completing this for your child, what is your child's date of birth?
Name
DOB
Address
City
State
Zip
Email
example@example.com
Are you a student? If so where
Are you employed? If so where
Are you a veteran? If so years of service and branch
YesNo
YesNo
Do you use any type of adaptive equipment (i.e. wheelchair cane prosthetics hearing aids etc)
HOUSEHOLD INFORMATION
ApartmentCondominiumSingle Family HomeOther
YesNo
YesNo
Please list type and breed of each
YesNo
YesNo
What tasks do you think a Service Dog could perform to make you more independent?
Other than specific tasks, how do you think a Service Dog can help you?
YesNo
By checking this box, I understand Service Dogs Alabama reserves the right to deny services to any applicant who does not meet the criteria necessary for placement of a Service Dog or who requires services not within the guidelines or capabilities of the organization. It is understood and agreed to that placement of an animal will require the fulfillment of the care and training guidelines of Service Dogs Alabama.
Name
Date

MonthDayYear
Date
Should be Empty:

Basic Information Form - Service Dog Program

HOUSEHOLD INFORMATION