Freedom Service Dogs Assistance Dog Inquiry Form 9-2026

Freedom Service Dogs Inquiry Form

Complete this form to express interest in our service dog and facility dog programs. Your responses help us understand your needs and eligibility to help us determine if our program might be a good fit for you. Our team will review your inquiry and contact you about next steps.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name

First NameLast Name
How would you like to be referred to?
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
City & State
Age
If completing this form on someone else's behalf, please enter their age.
Are you completing this inquiry form for yourself?
If no, please provide your name and describe your relationship with the individual who you are completing the inquiry for.
How did you hear about Freedom Service Dogs?
Have you previously applied for a service dog or facility dog through FSD or another organization?
If yes, when and with which organization?
Are you currently on any other waiting lists?
Which Freedom Service Dogs program are you interested in?
After selecting a program, please fill out the section that matches your selection.
- Are you a veteran or first responder?
- If yes, please explain (e.g., branch service, type of first responder, active or retired?)
- Is your PTSD service related?
- Do you have a PTSD diagnosis from a medical professional?
- Are you currently receiving treatment from a medical professional for your PTSD? (Please note, to be eligible for our program, you must currently be in the care of a medical professional for PTSD and have been for a minimum of 6 months)
- If yes, for how long?
- Are you currently in any type of inpatient treatment program?
- If yes, how long have you been in inpatient treatment and what for? (Please note, to be eligible for our program, you must have been out of inpatient treatment for at least 6 months)?
- Do you have any secondary diagnoses?
- If yes, please list:
- Do you need a service dog to assist you with any mobility or brace and balance needs? Due to high demand, we are only able to accept inquiries for PTSD-assist service dogs for veterans and first responders without mobility assistance needs at this time.
- If yes, please explain how:
- For veterans - are you able to provide proof of service and honorable discharge with a DD214 (member 4 copy)? For first responders - are you able to provide proof of employment as a first responder?
- Please share a brief summary addressing: how your PTSD directly affects your daily life and independence, why you are interested in a service right now, your relationship with dogs and the difference a service dog would make in your life.
  
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- What is your primary diagnosis that you would need service dog to help with?
- Do you have any secondary diagnoses?
- If yes, please list:
- Do you have an autism diagnosis from a medical professional?
- Do you have any secondary diagnoses?
- If yes, please list:
- What is your job title?
- In what type of facility do you work?
- Do you have supervisor/building management approval for a facility dog, and are you able to provide documentation of that approval?
- Please describe the population you work with and how a facility dog will assist you with your work:
- Please share a brief summary addressing: why you are interested in a facility dog right now, your relationship with dogs and the difference a facility dog will make in your work and the with population your serve.
  
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- Briefly describe what you would like a service dog to assist you with and identify at least 3 tasks you would like a service dog to perform to mitigate your disability.
- Will you require a dog to assist you in accessing public places? (e.g., grocery store, concerts, etc.)
- Do you anticipate any upcoming major changes in your life? (e.g., moving, new job, surgeries, etc.)
- If yes, please describe your upcoming change(s).
- Do you have any pets in the home?
- If yes, please list how many and what type of animal?
- Do you have a support person/community (e.g., family member, caregiver, partner, day programs etc.) who can assist you if needed?
- If yes, please describe their role.
- A service/facility dog can assist with many things, however, they are not a cure or quick fix and require ongoing care and engagement. Do you currently have the capacity to care for a dog and maintain the training of a service/facility dog?
- Living and working with a dog includes sensory experiences, such as drool, shedding, treat dust, licking, odors, and close contact. What reactions, if any, do you have in response to these experiences?
- Is there anything else you’d like us to know as we review your inquiry?
- FSD requires background checks on all applicants and anyone living in the household that is over the age of 18. Is there anything in your, or other household members’, criminal history (e.g., arrests, charges, or convictions) that you would like to disclose or provide context for?
- FSD requires monthly and annual reports to be submitted digitally. Is this something you are able to complete?
- I understand that if I were to receive an FSD Service Dog, I would need to travel to Colorado for a match meeting and 2 weeks of on-site training with my new dog. For an FSD Facility Dog, I would need to travel to Colorado for a match meeting and 1-2 weeks of on-site training with my new dog.
- I understand that if I were to receive an FSD Service or Facility dog, I would need to travel to Colorado a minimum of 5 times AFTER placement for travel for recertification tests.
- I understand this inquiry form does not guarantee acceptance into the Freedom Service Dogs program.
- I give permission for Freedom Service Dogs to contact me regarding next steps.
- What is the best way to reach you?
- Thank you for you interest in an assistance dog with Freedom Service Dogs.
  
  Due to the length of our waitlist, we are currently not accepting inquiries for mobility or autism assist service dogs. We recommend you do further research on other service dog organizations at Assistance Dogs International (ADI). ADI is a worldwide coalition of non-profit organizations that provide assistance dogs to individuals in need. www.assistancedogsinternational.org.
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Freedom Service Dogs Inquiry Form