PFI Service Dog Pre-Application
Please note- unless otherwise specified, individuals applying must be at least 16 years of age. 
Name *
First and Last Name
Email *
Phone Number *
Permanent Home Address *
Street address, city, state, and zip code.
What type of service dog are you interested in? *
Please provide a list of your current diagnosis/diagnoses and an approximate date of your diagnosis/diagnoses. *
Have you spoken to your doctor about if a service dog may be right for you? *
Does your doctor support the use of a service dog as part of your treatment plan? *
Please provide a brief description of your disability/disabilities. *
At what date was the onset of the disability? *
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How do your disabilities affect your life? *
Please watch this informational video in full.
Please confirm. *
Required
Do you live in an apartment building? *
Are you at least 16 years of age? *
Are you willing to agree to all individuals caring for or handling the dog being 16 years or older? *
By selecting "yes" you are agreeing that no one under the age of 16 will be responsible for the care or handling of this dog.
Do you have a valid driver's license? *
Are you currently attending school/college? *
College/School Name *
If you are not in school/college, write "N/A".
College/Temporary Address *
Street address, city, state, zip code. Write "N/A" if not applicable.
Are there any children in the home younger than 13 years of age? *
Are all members of your household in favor of and willing to provide care and support for the service dog? This includes complying with our program's standards. *
Who will be the primary caretaker of the dog? *
Must be 16 years of age or older.
In the event of an emergency, who would assume immediate care of the service dog?  *
What are some other commitments you have/will have? What hobbies are you currently involved with? *
This could include a sport, club, or your work/job.
How many hours per week do you attend these commitments? *
What is your previous experience with dogs? *
Handling, hunting, sports, obedience, showing, fostering, pet, etc...
Does the applicant work a full or part time job? *
How many hours per week does the applicant work? *
Write "N/A" if not applicable. 
If the applicant does work, is the a safe environment for a service dog? *
Write "N/A" if not applicable.
If no or unsure/other, please explain. *
Write "N/A" if not applicable.
Are you aware that as a PFI handler, you must follow all rules and instructions pertaining to the care and maintenance of a PFI dog? *
By selecting "yes" you are agreeing to follow all given rules and instruction provided to you.
Is the primary caretaker and/or applicant ready and willing to add the commitment of a PFI service dog into their lives? *
Are any family members allergic to dogs? *
If yes, are they willing to seek out medical attention when needed? Have they (or will they) receive proper treatment?  *
Write "N/A" if not applicable.
Have you had a service dog in the past? *
Do you currently have any pets in the home? *
If "yes", what kind(s) of pets? *
If you have a cat/cats, how do they react to dogs in the home? Please give a detailed description of the behavior and body language your pet shows. *
Write "N/A" if not applicable.
If you have a dog/dogs, how do they react to other dogs in the home? Please give a detailed description of the behavior and body language your pet shows. *
Write "N/A" if not applicable.
If you have a dog/dogs, what are their ages, sex, and neuter status? *
Write "N/A" if not applicable.
If you have a dog/dogs, how do they react to doorbells and strangers entering the home? Please be detailed. *
Write "N/A" if not applicable.
If you have a dog/dogs, how do they react to loud noises (including thunder, constructions, items dropping in the house, etc)? Please be detailed. *
Write "N/A" if not applicable.
If you have a dog/dogs in the house, how do they react to other animals (including other dogs)? Please be detailed. *
Write "N/A" if not applicable.
If you have a dog/dogs in the house, how do they react to prey animals (including squirrels, rabbits, deer)? Please be detailed.
 *
If you have a dog/dogs, have they ever shown aggression/intent to harm (biting or nipping resulting in puncture wounds or other injuries) to any adults or children, dogs, or cats? If yes, please be detailed. *
Write "N/A" if not applicable.
If you have a dog/dogs, have they ever shown reactivity (barking, growling, lunging, snapping, hard staring, posturing, raised hackles, etc.) to any adults or children, dogs, or cats? If yes, please be detailed. *
Write "N/A" if not applicable.
If you have a dog/dogs in the house, have they ever shown signs of resource guarding (growling, snapping, guarding the object, averted gaze, becoming tense upon being approached or passed when dog is in possession of resource, etc)? If yes, please be detailed. *
Write "N/A" if not applicable.
Are you able to provide vaccination status for all cats/dogs living within your home? *
Are you willing and prepared to take your PFI pup to a vet or nearest emergency vet whenever necessary? *
Do you have or have access to a fenced in yard? [A fenced-in yard is not mandatory] *
If yes, what is the height and type of fencing? *
Write "N/A" if not applicable.
Are you aware that PFI pups must never be off leash unless in an appropriate, enclosed area? (PFI Pups are NOT allowed to attend dog parks). *
How do you plan on exercising the dog? How frequently?  *
There will be a home-visit in order to ensure the home is a safe environment for a PFI pup. Are you comfortable with this? *
Do you have the ability to handle a large dog? *
Comments? Questions? Concerns? *
Write "N/A" if not applicable.
Why do you think a service dog is right for you? Please explain. *
Where did you hear about us? *
Media and Publicity Release

I hereby give Pawrtners for Independence the unqualified right to reproduce any media – including film, photographic prints, audio, video, or digital files – with or without my name or biographical data concerning me by PFI or another party on its behalf, without limitation as to time or frequency of use, for any or all of the following purposes:

  • Any Pawrtners for Independence publications and presentations (this includes any related uses).

  • Educational or instructional purposes

  • Publicity, marketing, or fundraising

  • Release to media, including broadcast, print, and electronic media (this includes all social media platforms) now known or later developed.

I understand that Pawrtners for Independence will try to notify me prior to using any media, and I understand that such notification is not always possible. 

I have read the above and foregoing and agree to all of the terms.
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Date *
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