Lend A Paw Inquiry Form

Lend A Paw Inquiry Application

Lend a Paw provides Service Dog prospects that have been medically and temperamentally evaluated for the work. We do not sell trained service dogs. Most dogs coming out of the program will have basic manners and possible remedial obedience. They have not been trained to individually task. Upon completion of this form, it will be reviewed and you will be contacted regarding setting up a virtual interview.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number - please list all numbers where you can be reached*
Please enter a valid phone number.
Can you receive text messages at this number?*

YesNo
Phone Number - please list all numbers where you can be reached
Please enter a valid phone number.
Can you receive text messages at this number?

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you are inquiring about a specific dog, please list name below.
Do you have any questions or concerns about this particular dog. *
If you are not inquiring about a specific dog, but have breed, size, sex, etc preferences, please list below.
Are you inquiring about a dog for you, or someone else. Please be specific*
Without disclosing your specific diagnosis, please list desired tasks to be taught. *
Do you have a price range in mind for acquiring a dog? (Please specify amount or range)*

Please rate your desired level of genetic traits. *

	Very High	Moderately High	Moderate	Pretty Low	Low	Nonexistent
Prey Drive
Defense Drive
Energy Level
Independence
Biddability
Attachment

Humans that share your home. *
Please list all individuals who will share a home with the dog. Include names, ages, relation to you, and if they will be responsible for providing any care for the dog, even minimal.
Animals that share your home and property. *
Please list ALL other pets (include breed, age, sex, and intact vs neutered) that are currently residing in or around your home. It is fine to paraphrase large quantities (ex. 20 cows in back pasture :-) ), but cats, dogs, household rabbits, etc, should all be listed separately.
Deceased pets or pets that have left your home. *
Please list any dogs or cats that are no longer in your home, but have been within the last 10 years. Please also include why they are no longer with you.
Do you live in a.....*
Do you.....*
Landlord Information
If you rent, please provide landlord name and contact information. While we realize that Service Dogs are allowed even when pets are not permitted, we prefer to place our dogs into situations free of conflict and contention.
How would you describe the overall activity level of your household?*
Daily Routine*
Please describe, with as much detail as possible, your daily routine and how & where your Service Dog fits into this. Be as detailed as you can.
Housing and Containment*
Please describe the environment where the dog will live? Is the yard fenced? What type of fencing and how much space? If not fenced, how will the dog be contained? Will the dog have full run of the house? or limited? Please be as detailed as you can.
Mental and Physical Stimulation*
Please explain how much exercise and training you anticipate this pet will need, and explain how you will provide for that.
Training Experience*
Have you trained a dog in any way previously? House hold manners? Tricks? Competition? Did you do this on your own or with assistance? If assisted, please list specific details.
Training Resources*
How do you plan to research and resolve any training or behavior concerns that could arise?
Relationship*
Briefly explain your concept/idea of the ideal human/dog relationship or household. What are your opinions on training philosophy, interactions, dynamics, etc.
Are you willing to have someone perform a home visit prior to placement?*
In no - please explain why.
Personal References*
Please list at least 3 people as personal references who give their permission for us to contact them by phone. Please list name, contact number and availability (if applicable).
Veterinary References*
Please list at least one veterinary reference who can attest to the current and past medical care of your pets. If you have never needed a veterinarian, please indicate that and list who you intend to use.
Additional Comments
Do you have any additional comments, questions or information that you would like us to consider as we review this application?
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Lend A Paw Inquiry Application