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SERVICE DOG APPLICATION
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1. FULLY-TRAINED ADA SERVICE DOGS - Financing with 650+ credit score. NO MONEY DOWN with up to 12 YEARS to pay.
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ADA Golden Retrievers, $40,000
ADA Miniature Australian Shepherds, $36,000
2. FINANCING AVAILABLE with your 650+ credit score. NO MONEY DOWN with up to 12 YEARS to pay.
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I was planning on just paying you
I want to finance my service dog with NO MONEY DOWN and A FEW HUNDRED DOLLARS a month payment
3. ARE YOUR PARENTS or SOMEBODY ELSE HELPING YOU PAY?
I am paying for my service dog with my own money
Somebody else is helping me pay
STOP!!! WE MEAN IT. Your parents 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.
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 21 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 21, 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, attorney or legal guardian must submit the application for you from their email address. We will not talk to you, unless we talk to your parents or legal guardian first. 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. 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 will be banned for life.
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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)
I am over 18 years old
I can afford to pay for the service dog I selected above
My credit is good with a 650 or higher credit score
10. ALL INFORMATION IS CONFIDENTIAL and not sold or shared with anyone.
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NO ONE WILL CALL OR CONTACT ME unless I call on the telephone first.
YOU MUST CALL US at (916)701-6458 AFTER YOU PRESS SUBMIT. NO ONE WILL CALL YOU unless you call us first. Your application will go in the trash and deleted if you do not call us. We will not talk to you unless you submit this application.
Submit Application