Evaluation Request
To request an evaluation of your dog, please fill out and submit the form below. We will contact you within 2 business days to set up an Evaluation appointment. **There is a $50 fee for evaluations which will be credited back to the purchase of any training program. Payment is required to hold the Evaluation time slot and is non-refundable. We understand life happens, so one re-schedule is allowed! We are looking forward to working with you!
About You
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Not including yourself, how many people live in your home?
*
Ages?
*
Do you have a fenced-in yard?
*
Yes
No
Do you have any other pets?
*
Yes
No
Explain
*
E-mail
*
Best Phone Number
*
-
Area Code
Phone Number
Birthday
*
-
Month
-
Day
Year
Date Picker Icon
Are you employed?
*
Yes
No
Where?
*
What (if any) equipment do you use?
*
Manual Wheelchair
Electric Wheelchair
Cane
Walker
Hearing Aide
Crutches
Prosthesis
Brace
None
How did you hear about us?
*
Friend
Internet Search
Facebook
Veterinarian
Other
About Your Dog
Name
*
Breed
*
Gender
*
Male
Female
Dog Birthday
*
-
Month
-
Day
Year
Date Picker Icon
Spayed/Neutered?
*
Yes
No
Spay/Neuter Date
*
-
Month
-
Day
Year
Date Picker Icon
How long have you owned the dog?
*
Where does the dog sleep?
*
Is the dog allowed on furniture?
*
Yes
No
Sometimes
What furniture and when?
*
Have you worked with dogs before?
*
Yes
No
Describe in detail: when, where, how long
*
Have you recieved training with this dog before?
*
Yes
No
Describe the dog's daily activities
*
Describe in detail: when, where, how long
*
Are you seeking to have your dog assessed for service dog training?
*
Yes
No
Please describe the nature of your disability. All answers will be confidential
*
Has your disability been diagnosed through a medical professional?
*
Yes
No
When?
*
-
Month
-
Day
Year
Date
Name of Diagnosis
*
Please explain:
*
It is necessary to have a letter from your attending medical professional indicating that a service dog would be beneficial for your diagnosed disability. Are you able to provide this letter?
*
Yes
No
Please explain:
*
What tasks do you need your dog to be able to perform?
*
Are you a veteran?
*
Yes
No
Branch:
*
Years of service:
*
Can you provide a DD-214?
*
Yes
No
Please explain:
*
Please select YES or No for each option below
Does your dog have problems with...
Excessive Barking
*
Yes
No
Explain
*
Chewing
*
Yes
No
Explain
*
House-Breaking
*
Yes
No
Explain
*
Digging
*
Yes
No
Explain
*
Jumping
*
Yes
No
Explain
*
Running Away
*
Yes
No
Explain
*
Chasing
*
Yes
No
Explain
*
Mouthing
*
Yes
No
Explain
*
Food or Toy Possesive
*
Yes
No
Explain
*
Dog Aggression
*
Yes
No
Explain
*
People Aggression
*
Yes
No
Explain
*
Other undesireable behavior
*
Rate how well the dog listens
*
1
2
3
4
5
6
7
8
9
10
Does NOT Listen
Extremely Responsive
1 is Does NOT Listen, 10 is Extremely Responsive
What are your specific goals for training with your dog?
*
Submit
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