Service Dog Application

Service Dog Application

Apply for a service dog by providing your personal and service need information.
Applicant Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What is your primary reason for needing a service dog?*
Please select your primary disability or condition*
Do you have any specific requirements or preferences for your service dog? (e.g., size, breed, temperament)
What tasks would be beneficial for the service dog to perform?
YesNo
Describe your experience with dogs (if any)
YesNo
Describe your home environment (e.g., living situation, accessibility)
YesNo
YesNo
If yes, please describe your family members and their relationship to you
YesNo
Please provide detailed information about your current personal pets (types, numbers, names, spay/neuter, behavior, health, etc.).
YesNo
Are there any major changes planned for your home, pets, or people in the near future? Please describe.
Upload any supporting documents (e.g., medical note, at least 2 reference letters are required- one cannot be direct family/partner/spouse)

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