Application for Service Dog Program

PLEASE only complete this application if :
1- You are a COMBAT veteran diagnosed with PTSD/TBI AND
2- You are Located within a reasonable driving DISTANCE TO us AND
3-Honorably Discharged

We will contact you within 7-10 days of submission. Please check your trash/spam folder if you do not hear from us within the above timeframe

* Indicates required field

Name *

First

Last

Physical Address (including street, city and state *

Email *

Phone *

Have you been diagnosed with PTSD? *

Yes No

Have you been diagnosed with TBI? *

Yes No

Are you considered disabled by the VA? *

Yes No

Please list your symptoms and any other injuries *

Do you currently have a dog? *

If yes, please describe. *

What branch did you serve in? *

Where did you deploy? *

Submit