Contact us.Phone number: (786) 432-7782Email: 333 SE 2nd Ave Suite 2000 Miami Fl 33131. Wells Fargo Plaza. Application Form Name Physical Address City * State Zip Code * Email Phone (###) ### #### Are you a parent/ guardian completing application on behalf of a minor? * Parent/Guardian name (if child is under 18 years of age). Have you owned a dog before? * Yes No What type of house do you live in? * Apartment Single Story/Two Story House High Rise/Condo Other Do you have a fence in yard? Yes No What is your primary method of transportation? * Make and Model (if you use a car for transportation) * Please list the individuals living in your household (Name, Age, Relationship) * What dog breed are you interested in getting as your service dog? * Labrador retriever Golden retriever Standard poodle ? * What gender would you like your service dog to be? * Please list all the animals living in your household (age, gender, species, spayed/ neutered?) * Will there be additional animals visiting your home on a consistent basis? * Are you a student? Yes No Are you employed? * Yes No If employed, please describe your type of work. What type of duties do you perform while at work? What is your typical work environment like (are you at a desk or out in the field)? Are you familiar with the cost associated for purchasing a service dog? * Yes No Will you like your service dog delivered to your home or picked up from our trainer in Las Vegas, NV? * Please list your common activities, hobbies or sports (this is so we can train your future service dog around these specific activities). Please describe your typical day * How would you describe your personal level of energy (this is for dog matching and training purposes)? How would you describe the overall energy level of your household? * On an assertiveness scale (from 1 to 10) where do you feel you measure when working with animals? 1 being shy, reserved, soft-spoken (no dog handling experience) and 10 being assertive, confident and commanding (previous dog training experience)? What type of diabetes do you have? * Are you insulin dependent? * Do you use an insulin pump? * Yes No Do you use a Continuous Glucose Monitor (CGM)? * Yes No Is this service dog being provided for someone who has autism? * Thank you!
