DutyDogs.com

Application Process

Please fill out and submit the following form


Name
Address
City
State
Zip
Phone
Best time/way to contact you?
Email
Is the dog for you or a family member?
If other than you, who in the family?
What is the age of the person?
Do you have other pets?
If so, what do you have and how many?
Dog/Cat
Age
Spay/Neutered
Have you ever owned a service dog?
If so, from what organization?
Describe your lifestyle (work, activity level, social activities—clubs, sports)
Will the dog accompany the person to school/work outside of the home?
What modes of transportation do you use for commuting?
Describe where you live? (neighborhood, city, country, farm, house, apartment, townhouse, one-story, two-story, three-story, fenced yard, access to grassy/wooded area, paths/sidewalks)
How many adults/children are in the home?
Age/Relationship?
Describe any disabling medical conditions, including Type 1 or 2 diabetes
Does anyone in the home suffer from dog allergies?
Does anyone in the home smoke?
Have you discussed getting a service dog with your doctor?
What is your current A1c? (Optional)
Comments (Optional)
 
     

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