Your details
Name
First Name
Last Name
Email
example@example.com
Age of the primary handler
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
🐾 Dog Ownership & Household Environment
- What type of home do you live in? (House, Unit, Acreage, Other)
House
Unit
Acreage
Other
Do you Rent or Own
Rent
Own
Please describe everyone living in your household, including other pets. Include ages, species, and any relevant dynamics.
💼 Lifestyle & Support System
- Are you currently employed? Please outline your work schedule and any flexibility you have.
- How many hours a day can you realistically commit to training and caring for your dog?
- Do you have a support system (family, friends, carers) who can assist with dog care or training if needed?
🧠 Learning Style & Program Fit
- What experience do you have raising or training dogs or puppies?
- Have you had an Assistance Dog before? If yes, please share details.
- What specific tasks or support would you like an Assistance Dog to provide for you at home and in public?
- How do you handle stressful situations, especially when working with animals?
- How do you prefer to learn new skills? (e.g., watching videos, reading, hands-on practice, live coaching)
- Have you completed any online courses before? If so, what worked well for you and what didn’t?
- Do you have reliable internet access and a device suitable for watching training videos and joining online sessions?
- Are you comfortable using email, video calls, and online platforms to receive support and submit progress updates?
- Are you comfortable videoing yourself for weekly progress submissions
Are you wanting to wait to be in the program ?
I am in no rush
I would like to start as soon as possible
I would like to start soon but am happy to wait if needed
- Is there anything else you’d like us to know about you, your home, or your goals?
Disability &Functional Support Needs
How does your condition impact your routines, community access, emotional regulation, or independence?
What types of support do you currently use (e.g., therapy, medication, mobility aids, support workers)?
In what ways do you believe an Assistance Dog could help you manage or navigate these challenges?
Are there specific tasks or alerts you’d like your dog to be trained for (e.g., sensory interruption, anxiety response, mobility support, medication reminders)?
- Are you an NDIS participant? If so, does your plan support skills and training?
Have you discussed Assistance Dog support with your healthcare provider or NDIS planner? If so, what feedback or recommendations have they offered?
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