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First name(Required)

Last name(Required)

Email(Required)

Phone

Address(Required)

Do you currently have a dog you wish to train?(Required)

Yes

Dog's Name, Breed, Age(Required)

How long have you had this dog?(Required)

Has your dog had any prior training?(Required)

Is your dog comfortable being touched by everyone (on head, body, paws)?

Yes

How does your dog typically behave around new people or environments?

Are there any other pets in the household?

Yes

If yes, please describe them briefly (age, breed, temperament)

Are you seeking:(Required)

Service Dog Training

Therapy Dog Training

Not Sure / Need Help Deciding

Do you currently have a diagnosis or condition that qualifies you for a service dog?(Required)

Yes

Note: Medical documentation may be required for service dog training

Are you a U.S. military veteran?(Required)

Yes

Documentation might be required for service dog training

If a service dog, what kind of service does the dog provide

Psychiatric Support

Medical Alert

Food Allergen

Autism

What tasks do you want the dog to help with?

Have you spoken with a health professional about using a service dog?

Yes

Describe your living environment (apartment, house, yard access, etc.)(Required)

Do you have time to train and care for a dog consistently?

Yes

Not sure - I'd like to discuss further

What kind of therapy work are you interested in doing with your dog?

Hospital or medical visits

Schools or Libraries

Assisted living or senior centers

Workplace or community visits

Other

Is there anything else you'd like us to know about you and your dog?

How did you find out about our program?

Referred by a friend or family member

Referred by a medical or mental health professional

Social Media

Google or online search

Event or community outreach

Flyer or brochure

Other

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