Service Dog Application Form
Contact Information
First Name
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Last Name
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Email
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Phone
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Location
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How Did You Learn About Us?
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About Your Dog
Dog's Name
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Write "None" If You Don't Have And Click Next Button
Dog's Breed
Dog's Age
Kindly Indicate Years/Months/Weeks Old
Dog's Sex
How would you describe your dog's personality?
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Write "None" if you don't have a dog yet
How does your dog behave around strangers?
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Write "None" if you don't have a dog yet
How does your dog behave around other dogs?
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Write "None" if you don't have a dog yet
How does your dog behave around children?
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Write "None" if you don't have a dog yet
How does your dog behave in public? loud noises?
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Write "None" if you don't have a dog yet
Are you currently struggling with any issues with your dog?
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Write "None" if you don't have a dog yet
Why do you think your dog would make a good service dog?
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Write "None" if you don't have a dog yet
What are some things you would like your dog to do to help you assist with your disability/situation?
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Write "None" if you don't have a dog yet
About Your Situation
What is/are your situation/s?
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What type of service dog training are you looking for?
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Psychiatric Assistance
Mobility Assistance
Allergen Detection
Hearing Alert
Medical Alert (Diabetic, Seizure, POTS, etc.)
You can choose multiple choices
What other solutions or supports have you tried to address your challenges before turning to a service dog?
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Ex: I'm doing Physical Therapy weekly to help me with my mobility.
Would you feel comfortable sharing your medical provider’s information for verification purposes?
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Yes
No
Have you worked with a professional service dog trainer before?
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Yes
No
What is your ideal timeline to begin training?
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Immediately (Within 1 month)
Within 3 months
More than 3 months from now
What is your preferred way to receive training?
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In-person
Virtual
Combination of In Person & Virtual
Board & Train My Dog
Are you ready to dedicate at least 2 years to your dog’s service training journey?
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Yes
No
Not Sure
Would you like to schedule a phone consultation to discuss your needs and our program?
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Yes
No
By submitting this form, you agree to receive text messages from Meika’s Helping Paws regarding scheduling, appointment reminders, and dog training related updates. Message and data rates may apply. Reply STOP at any time to opt out.
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Yes
No