Evaluations

Help us Find the Perfect Pup for You!

Name:

Phone:

Gender:

Email:

Address:

Age:

Diagnosis / Illnesses:

Household Information

Please list the members of your household & their ages (including children):

Please list any of pets in your household, breed & age:

Have you owned a dog before?

Have you trained a dog before:

Do you rent or own your home?

What type of dwelling is it (apartment, house, etc.)

Do you have a yard / outdoor area? Please describe the area & approximate size:

Owner Information

What are your goals for having a psychiatric service dog?

How do you plan to care for your psychiatric service dog?

How will you spend your time with your psychiatric service dog?

What qualities are you looking for your psychiatric service dog to have?

When do you plan to get your psychiatric service dog?

Any additional information you’d like to add?

Thanks for submitting!