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?
Do you currently own any pets?
Describe your experience with dogs (if any)
Are you okay being waitlisted until a service dog is available?
Describe your home environment (e.g., living situation, accessibility)
Have you applied to another organization for a service dog?
Do you have other family members living with you?
If yes, please describe your family members and their relationship to you
Do you have any other pets besides the service dog?
Please provide detailed information about your current personal pets (types, numbers, names, spay/neuter, behavior, health, etc.).
Do you currently have any dogs with behavioral problems?
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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