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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. Did a MEDICAL DOCTOR or THERAPIST recommend an ADA-COMPLIANT SERVICE DOG? (Not an Emotional Support Animal)
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Yes
No (Not disqualifying)
2B CLICK ALL THAT APPLY TO APPLICANT:
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I have a mental or physical disability
I do not have a mental or physical disability
Somebody has money and just wants the best dog and trainer
3. MEDICAL DIAGNOSIS (Click all that apply). If the applicant is TOO SICK, too depressed, too anxious, too unpredictable, unstable, or detached from reality, etcetera, getting a service dog would not be in anyone's best interest.
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PTSD
Traumatic Brain Injury
Depression
Narcolepsy
Anxiety Disorder
Borderline Personality Disorder (BPD)
Autism
Sleep Disorder
Medical Disability
Other (Specify in the comments section below)
4. TASKS YOUR DOG WILL BE TRAINED TO HELP WITH. (Click all that apply)
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Public Access
Reduce Medications
Go to work or school with you
Alternative to drugs
Alert to mental or medical distress
Interrupt Behaviors
Deep Pressure Therapy
Help you sleep
Fear of leaving home
Help with social interaction
Panic or Social Anxiety
Help with mobility
Stop suicidal ideation
Bring joy into your life
Make you more productive
Give your life meaning
To stay in school or keep working
Other (Explain in comments below)
5. BRIEFLY, Your Story. Who are you, what do you do, what happened, etc?
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6. How will getting a service dog make you, your spouse, or your child, a MORE PRODUCTIVE and HAPPIER PERSON?
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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 CHILD OR SPOUSE who needs a service dog:
APPLICANT'S AGE (Age of the person who needs a service dog)
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Email
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State
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City
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Telephone
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7. FULLY-TRAINED PSYCHIATRIC & AUTISM SERVICE DOGS
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$46,000, payment plans available
I CANNOT AFFORD TO PAY YOU
7B. HOW WILL YOU PAY?
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I have my own money (or, I am the parent and have money to pay)
MY PARENTS or somebody else is paying
7C. DO YOU ALREADY HAVE THE MONEY to buy a service dog?
Yes, I already have money to pay
I have at least half and can make payments
No, I don't even have half for a down-payment
STOP!!! DO NOT SUBMIT THIS APPLICATION YOURSELF. Your parents or whoever is paying must submit an application for you.
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For free and low-cost service dogs, Google "service dog charities."
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DO NOT SUBMIT THIS APPLICATION or GET MAD AT US. Please, you need to Google "service dog charities" to get the help you need. Charities help people with little or no money get service dogs.
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MEDICAL INSURANCE, Social Security, the VA, and Make-A-Wish DO NOT buy service dogs.
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WE PROMISE TO CALL YOU WITHIN 48 HRS. or you can speak to the owner at (916)701-6458 during business hours for faster service.
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We look forward to talking to you
Submit Application