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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
APPLICANT'S AGE (Age of the person who needs a service dog)
*
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
Syncope
Mobility Issues
Chronic Pain
Self-Harm or Suicide Attempts
Ehlers-Danlos Syndrome (EDS)
Other (Specify in the comments section below)
4. YOUR STORY. Who are you, what do you do, what happened, etc?
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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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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
*
State
*
Telephone
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Email
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ADA PSYCHIATRIC and MEDICAL SERVICE DOGS with 10 to 12 months training. Payment plans available, but all dogs must be paid for before going home.
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Total Cost: $46,000, All-Inclusive Program
I CANNOT AFFORD TO PAY
WHO IS PAYING?
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I am paying 100% of the cost myself (or for my child's dog)
MY PARENTS or somebody else will be helping me
WHEN DO YOU WANT YOUR SERVICE DOG? The ADA requirement is that service animals be "individually trained to do work or perform tasks for the benefit of an individual." YOUR DOG MUST BE TRAINED FOR YOU.
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I need my service dog yesterday
In about 6 to 12 months
PLEASE DO NOT SUBMIT THIS APPLICATION or GET MAD AT US. 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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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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For free and low-cost service dogs, Google "service dog charities."
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ASSUMING YOUR APPLICATION IS APPROVED, WHAT SPECIFIC OUTCOME(S) are you looking for after you talk to us?
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Put down a deposit
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