Service Dog Training Form

First name

Last name

Cell Phone

Pronouns

Email

Address

Preferred Form of Communication

Email

Call

Text

Please list all household members and their ages.

Who will be the handler of the dog?

Which person(s) will be requiring the skills of the service dog? (The person with the disability)

Please give any additional contact information you would like us to have.

If you already have a service dog prospect please answer the questions in the following section. If you do not please skip this section.

Dog Information section:

Dog’s name

Dog’s breed or mix (size of mix)

Dog’s age or date of birth

How long have you had your dog and what was their personality like when you first brought them home?

Why did you decide to get this dog in particular?

Describe your experience with raising and training dogs in the past.

What kind of equipment do you use to walk your dog?

Describe what is like walking your dog.

If your dog fully housebroken? If so how do you know when they have to go out?

Under what circumstances does your dog bark and how often does this occur?

Under what circumstances does your dog jump up on people or objects in an undesirable way?

What is your dog’s reaction to cats, squirrels and/or other wildlife.

What is your dog’s reaction to seeing another unfamiliar dog?

Please describe and destructive behaviors your dog might have around the house. (ie chewing, getting into the trash can, marking, digging etc)

Please describe under what circumstances your dog has growled at or bitten any person or animal.

Please describe everything your dog is uneasy about or fearful of.

Does your dog enjoy traveling in the car?

Yes

No

Gets car sick (no)

Does your dog ever pee when excited or nervous?

Yes

Sometimes

Never

Is your dog ever mouthy with you? When?

Describe all of the ways you have tried to stop an unwanted behavior of your dog.

Would you say that your dog listens to you well even when distracted?

Would you say that your dog is perfectly comfortable with strange adults and children?

How often do you bring your dog on outings where they see new people , sights and sounds?

Does your dog have any allergies, food sensitivities or other known medical issues?

Has your dog ever had any previous training? If so please describe the duration and experience.

Home Life and Service Dog Needs Section:

Please summarize yourself and your life style. Describe work, school, hobbies, and any other important information about your activities.

Please describe your living space. Are there stairs, an elevator, open floor plan, access to yard etc.?

Please describe your daily routine and how a dog will/does fit in that routine.

What family member(s) have/will have responsibility for caring for your dog. (Feeding, exercise, etc.)

Please list any additional pets you have in your home. How do they get along with dogs?

Please describe your yard or exercise area you have for the dog. (Fence, no fence, tether, courtyard, large acreage, etc.)

What daily exercise routine can you provide for your dog?

Will the dog have restricted access within the household? If so please elaborate.

How long is/will the dog be left alone at home during the day and where will they be contained during this time?

Where would you prefer your dog to sleep at night?

How often do you travel regularly and how will the dog be cared for while you are away?

If you were to have something happen to you that prevented you from training your dog do you have someone who can keep up with the training in your absence?

How often will you be able to train your dog? Please include how often you will be able to take them on outings for training.

Please list local public spaces that you can go to train your dog to handle distractions.. ie Parks, shopping centers, down town areas, malls, public transportation, stores etc.

Will your service dog be required to go to work or school with you? Please elaborate.

Will your dog need to ride public transportation.? Please be specific.

Do you feel that you have the support of family and friends when it comes to having a service dog in your life?

Disability Related Questions

Please only answer these question if and in a manner that you are comfortable.

Please summarize your main reason for wanting a service dog.

Please describe your symptoms that you experience that you feel a service dog would be able to assist you with. (You can list your disability or diagnoses if that is easier)

What skills do you feel a dog can perform which will help make your life easier?

Do you have an specific triggers that make your symptoms worse?

Are there any places that you find more difficult to go to because of your disability?

When you think of utilizing the help of a service dog out in public while going about your day to day life, how does that make you feel?

When you think about the added attention you will get having a dog with you in public places where dogs are usually not allowed, how does that make you feel?

Do you have any concerns about training or using a service dog, or about your dogs abilities to become a service dog?

Is there anything else that you would like us to know?