Service Dog Application:

Please read the following terms, then click Next to continue. Please note: this application is rather extensive. Please allow yourself some extra time to complete it.

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Today's Date:


Name:


Date of Birth:


What is your Occupation? |

Contact Info - Part 1 of 2:

Contact Info - Part 2 of 2:

Life and Military Information - Part 1 of 3:
Please choose one option from each question
Are you...?: | | | |

Have you served in the Military? |
Life and Military Information - Part 2 of 3:
Almost finished. Just a few more questions
Do you consume alcohol? |
Do you live alone? |
Life and Military Information - Part 3 of 3:
What is a typical day like for you?


How would you incorporate the dog into your day?


How would you exercise your dog?


Have you had dogs previously? |
What, ideally, would you like for your dog to be able to do for you?
Final Questions:
Do you have physical limitations?


What are your opinions of dogs?


In your own words, please describe how you think having a PTSD SERVICE DOG would allow you to become more independent? Less fearful? Less anxious? etc:


How would you respond to the challenges of having a PTSD SERVICE DOG in public places where there might be questions as to its certification and ability to be allowed? What would you say?


Last Question! In what format would you like to recieve correspondence?
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That's it! Hit submit to send your application.