Service Dog Candidate Form

* Indicates required field

Your Name *

First

Last

Pronouns *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Other Household Members *

Do you already have a dog you'd like to use as your service dog? *

Yes No No, and I'd like help finding one

How do you imagine your dog helping you? (If you aren't sure, we can discuss that!) *

What are some examples of locations where you would like to be able to have your service dog assist you? *

Are there any accommodations you would need for training sessions? *

What else would you like me to know about you? *

If you already have a dog, tell me about them here! *

Submit