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

Zip Code

House Phone

Cell Phone

Preferred Contact Method

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)

How did you hear about us?

*Please note that we classify first responders as: Police, Fire, and EMS only.