Service Dog Application Request Form
To request a Service Dog Application, please submit the request form below:
First Name (required)
Last Name
Email (required)
Address
City
State
Alabama
Alaska
Alberta
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Zip Code
House Phone
Cell Phone
Preferred Contact Method
Email
Home Phone
Cell Phone
What tasks do you want the dog to do to help mitigate your disability/disabilities?
Is the person applying in need of a service dog a... (required)
Veteran
Former First Responder*
Civilian
Veteran and Former First Responder*
How did you hear about us?
*Please note that we classify first responders as: Police, Fire, and EMS only.
Primary
Spouse
Partner
Child
Other