SERVICE DOG APPLICATION

If you are a Veteran and would like to apply for a Service Dog, please print out this PDF form (30KB) and fill it out or you can also fill out the form below.

Your Name*
First Last
Email*
Primary Phone*
Mobile Phone
Address
Street Address Address Line 2 City State ZIP Code
Emergency Contact Name
Emergency Contact Phone
What branch of the military were you in and when were you discharged?
Do you have a dog for training?
- Yes
- No
Medical information
What is the nature of your disability?
- PTSD
- Physical Mobility
- Both
Are you in a VA PTSD program?
- Yes
- No
How were you referred to Service Dogs 4 Servicemen?

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