Application for a Service Dog – Training with YES

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Application for a Service Dog

Home
About
Services
Contact
Application for a Service Dog

Help us get to know you by submitting this application for a service dog. We will NEVER lie to you. Please take care to extend the same courtesy to us.

Name

Email *

What is your Phone Number?

What is your address, city and state?

What is your age? (and the age of the person needing a service dog if not you):

Who will be paying $50,000 price for your service dog (please provide details including a phone number for who is paying (if not you):

Tell us the ages, breed, sex, and temperament of any dogs you may be living with currently:

How much experience have you had with dogs in the past?

Will their be family members or others who will assist you with the care of your Service Dog? (please provide details)

Reason(s) you need a Service Dog: (check all that apply)

Public Access
Behavior Interruption (calming)
DPT (Deep Pressure Therapy)
Reduce reliance on medications
Travel to work/school with you
Improve Social Circumstances
Alert to Anxiety signals
Improve your sleep
Reduce suiciadal thoughts
Act as a soft barrier between you and others
Add the Joy and Love to your life that you deserve
Other (comment below)

Other behaviors not listed above:

Medical Diagnoses from a Physician

PTSD
Anxiety Disorder
Bipolar
Autism
Medical Disability
Other (comment below)

Other Diagnoses from a Medical Professional (not listed above):

Tell us your story, what you do, what led to your need for a Service Dog, activities you enjoy or dislike, etc.:

Home
About
Services
Contact
Application for a Service Dog

Training with YES