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SERVICE DOG APPLICATION
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READ THIS FIRST: We have A SERVICE DOG FOR YOU in 2023. We are the #1 service dog trainer in America. We care and are here to help you, but we cannot give somebody a dog if they are too sick, weak, unstable, or detached from reality.
1. FULLY-TRAINED ADA SERVICE & THERAPY DOGS
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ADA Golden Retrievers, $40,000
2. HOW WILL YOU PAY THE $40,000?
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I can pay now by check or use my credit card
I can pay off the balance by December 2023
Somebody else is paying
STOP!!! WE MEAN IT KIDS UNDER 18. Your parents, conservator or the person helping you pay must submit this application. If you lie to us about anything, especially your age or about your financial status, you can forget about getting a service dog from us now or ever.
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3. PLEASE TYPE, "This is NOT A CHARITY with free service dogs."
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4. MEDICAL DIAGNOSIS (Click all that apply)
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PTSD
Autism
Depression
Traumatic Brain Injury
Anxiety Disorder
Other (Specify in the comments section below)
5. AGE when mental health issues first began and/or diagnosed.
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6. Did the applicant's DOCTOR or THERAPIST RECOMMEND a service dog?
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Yes - Not required for ADA dogs
No
7. REASONS TO GET A MEDICAL SERVICE DOG. (Click all that apply)
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Help for severe, disabling depression
I am housebound
To stop the suicidal ideation
So I don't have to be alone
An alternative to psych meds, booze and/or dope
Distract me from chronic pain
So I can sleep at night
Reduce or eliminate psych meds
Reduce anxiety
Wake me from nightmares
Help with racing or recurring thoughts
Give me meaning in my life
APPLICANT - PERSON FILLING OUT FORM (Must be at least 18 years old)
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First
Last
NAME OF CHILD OR SPOUSE who needs a service dog:
APPLICANT AGE (Age of the person who needs a service dog)
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THE PARENT or PERSON answering the questions and submitting this application:
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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. The person paying, OR your parents, attorney or legal guardian must submit the application for you from their email address. We will not talk to you, unless we talk to the person paying, your parents or legal guardian first. AGAIN, It does not matter your age, even if you are over 100 years old. IF SOMEONE ELSE IS PAYING OR HELPING YOU PAY, they must apply for you. ANY DISHONESY OR LYING ABOUT YOUR AGE OR FINANCES, and you can forget about getting a service dog from us now or ever.
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City
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State
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Email
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Telephone
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8. Your Story. Who are you, what do you do, what happened, etc?
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9. MORE INFORMATION about YOURSELF you would like considered. (Optional)
10. ALL INFORMATION IS CONFIDENTIAL and not sold or shared with anyone. (CLICK ALL THAT APPLY)
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I understand this is about BUYING a fully-trained service dog.
11. SUBMIT APPLICATION, and then CALL (916)701-6458 to be considered for our program.
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THE SQUEAKY WHEEL gets oiled. Call the office at (916)701-6458 to be moved to the front of the list and considered for our program.
Submit Application