First Name
*
Last Name
Email
*
Phone
*
Have you been diagnosed by a doctor with a disability that requires a service dog?
*
Yes
No
What is your disability?
When were you diagnosed?
Do you have a note from your doctor or can you get one?
Yes
No
Are you prepared to invest an average of $500/month over a 2-year period AND 10 to 12 hours a week to train your service dog? You will be working on obedience, tasking, environmental exposure and socialization in addition to daily monitoring and behavior management 24-hours per day.
Yes
No
Are you physically and mentally able to train and care for a service dog? Or have the support you need to properly train and care for a service dog?
Yes
No
What Type of Service dog are you inquiring about?
Diabetes Alert Dog
Seizure Dog
Mobility Dog
PTSD
Psychiatric
Autism
Anxiety/Fear
Allergen Detection
Migraine
POTS
Crohns
Other
What is your A1C Level?
Do you work with an endocrinologist?
If allergen, what is the allergy to?
If other, please explain:
Please list the tasks you want your dog trained to perform?
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