Service Dog Request Form (In Search Of A Service Dog)

Service Dog Request Form (In Search Of A Service Dog)

Share your needs and details to request a service dog.
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
Please describe your disability or condition as much as you feel comfortable for which you require a service dog.
What type of assistance do you need from a service dog?

Other- Please Describe Below
Please explain how a service dog would help you in your daily life.
Do you currently have any other Dogs at home?
Have you previously owned or cared for a dog?
Please explain your lifestyle (This will assist in breed matching)
Is there anything else you would like us to know about your situation or your request?
Are You Interested in a Puppy, Young Adult or Pairing Ready Adult Service Dog?
Please Explain Your Budget abilities and Time frame you need the dog in. - We Accept Affirm Payment Plans and will attempt to work with you in a realistic way.
Should be Empty: