Service Dog Application

Apply for Service Dog

First Name

Last Name

Age

Street Address

Street Address Line 2

City

Postal / Zip code

Region/State/Province

Phone

Employer

Occupation

Primary Diagnosis & Limitations:

List any other medical conditions:

How active is your lifestyle and what are your daily physical activities?

What type of residence do you live in? Is it fully fenced? If yes, what type? If no, how will you exercise the animal?

What are the ages and names of others living in your household? What type of pets do you have?

What do you think a Service Dog is? What tasks are you needing?

Are you dedicated to exercising the service animal?

Do you understand that a Service Animal requires a lifetime of training?

Do you make enough money to feed and pay for the Service Animals expenses, which include but are not limited to Vet Care, Grooming, Training Expenses, etc? If no, please explain.

Are you willing to educate yourself pertaining to the laws regarding Service Dogs and the ethics that relate to them?

Thank you! We will give you a call at your scheduled time!