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Service Dog Application
SERVICE DOG APPLICATION
Please enable JavaScript in your browser to complete this form.
PERSON FILLING OUT THIS APPLICATION:
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First
Last
1) THE PERSON ANSWERING THE QUESTIONS:
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I'm an ADULT OVER 18, applying for myself
I'm an ADULT OVER 21, applying for my child, spouse or parent
I am younger than 18 years old
STOP!!! DO NOT SUBMIT THIS APPLICATION YOURSELF. Your parents, conservator, attorney or legal guardian must submit the application for you from THEIR EMAIL ADDRESS. We cannot talk to you if you are UNDER 18 YEARS OLD. If you LIE ABOUT YOUR AGE or IMPERSONATE YOUR PARENT, you will NEVER get a service dog and be banned from ever re-applying.
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PLEASE. DO NOT SUBMIT THIS APPLICATION. It will just go in the trash and be deleted, and you will make people mad at you for not following instructions and wasting our time.
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2) APPLICANT'S AGE (Age of the person who needs a service dog)
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3) MEDICAL DIAGNOSIS (Click all that apply).
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PTSD
Traumatic Brain Injury
Depression
Narcolepsy
Anxiety Disorder
Borderline Personality Disorder (BPD)
Autism
Sleep Disorder
Syncope
Mobility Issues
Chronic Pain
Self-Harm or Suicide Attempts
Ehlers-Danlos Syndrome (EDS)
Other (Specify in the comments section below)
4) On a scale from one to ten, HOW MENTALLY TORMENTED or IN PAIN ARE YOU at your worst moment on a typical day? 1 = Good, 10 = Miserable.
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5) YOUR STORY. 1) Who are you, what do you do, what happened, why do you think a service dog would help you, what are your plans the next 10 years, etc?
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6) PRICES FOR SERVICE AND THERAPY DOGS. The exact price you will pay is determined during the application process.
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Class of 2025 & 2026, $40,000 to $55,000
I cannot afford to pay
PLEASE DO NOT SUBMIT THIS APPLICATION or GET MAD AT US. You need to Google "service dog charities" to get the help you need. 501(c) charities help people with no money get service dogs. We are a business not a 501(c) charity.
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For free service dogs, Google "501(c) service dog charities."
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PLEASE!!! DO NOT PRESS THE SUBMIT BUTTON. You definitely want to contact a "501(c) service dog charity" to get a free service dog.
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7) WHO IS THE ONE PAYING?
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I am paying 100% of the cost myself (or, I am the parent paying)
Somebody else is paying, or helping me pay
STOP!!! DO NOT SUBMIT THIS APPLICATION YOURSELF. Your parents or whoever is paying must submit an application for you.
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MEDICAL INSURANCE, Social Security, the VA, and Make-A-Wish DO NOT buy service dogs.
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APPLICANT - Person who needs a service dog or parent applying for them.
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First
Last
(IF APPLICABLE) NAME OF THE CHILD OR SPOUSE who needs a service dog:
City
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State
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Telephone
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Email
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STOP!!! PLEASE DO NOT SUBMIT THIS APPLICATION!!!
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THANK YOU FOR APPLYING! For faster service, please call our office at (916)701-6458 after you submit this application.
Submit Application