D.A.D. Application
DIABETIC'S NAME *
Your answer
DIABETIC'S BIRTHDATE *
MM
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DD
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YYYY
PARENT OR GUARDIAN IF MINOR
Your answer
WHAT TYPE OF DIABETES (OR OTHER CONDITION AFFECTING THE REGULATION OF BLOOD GLUCOSE) DOES THE INDIVIDUAL HAVE? *
DOES THE DIABETIC HAVE ANY OTHER MEDICAL CONDITIONS IN ADDITION TO DIABETES? IF SO, PLEASE LIST ALL. (e.g. Anxiety, celiac disease, thyroid disease. This is necessary because some conditions affect the dogs' abilities to alert.)
Your answer
WOULD YOU LIKE THE DOG TO BE TRAINED FOR ANY OTHER DISABILITY RELATED TASKS AS WELL, IF POSSIBLE? (ALLERGEN DETECTION, HEARING ALERT, ETC.)
Your answer
PRIMARY PHONE *
Your answer
SECONDARY PHONE
Your answer
EMAIL *
Your answer
ADDRESS *
Your answer
CITY *
Your answer
STATE *
Your answer
DIABETIC'S AGE *
Your answer
AGE AT DIAGNOSIS *
Your answer
DATE OF LAST A1c *
MM
/
DD
/
YYYY
RESULT OF LAST A1c *
Your answer
WHAT IS YOUR GOAL A1c? *
Your answer
HOW OFTEN IS THE BLOOD SUGAR CHECKED? *
HOW IS YOUR BLOOD SUGAR MANAGED? *
Required
AT WHAT NUMBER IS LOW BLOOD SUGAR USUALLY FELT?
Your answer
SOMETIMES IT IS POSSIBLE TO PREDICT AN OUT OF RANGE BLOOD SUGAR (AFTER A MEAL, EXERCISE, ETC.).HOW REGULARLY DOES AN OUT OF RANGE BLOOD SUGAR READING TAKE YOU BY SURPRISE? *
ARE YOU LOOKING FOR A DOG TO ALERT YOU TO LOWS OR HIGHS OR BOTH? *
WHAT RANGE DO YOU WANT TO KEEP YOUR BLOOD SUGAR? *
What numbers would you ideally like the D.A.D. to alert to?
Your answer
DO YOU LIVE IN A: *
DO YOU HAVE A YARD? *
IF SO, WHAT SIZE YARD DO YOU HAVE?
IS YOUR YARD FENCED?
DO YOU OWN THE HOME YOU LIVE IN? *
PLEASE LIST ALL MEMBERS LIVING IN THE HOME, AS WELL AS THEIR AGES AND RELATIONSHIP TO THE DIABETIC *
Your answer
PLEASE LIST ANY OF THE FAMILY MEMBERS WHO WORK OR ATTEND SCHOOL, AND WHETHER IT IS FULL-TIME OR PART-TIME. *
Your answer
DO ANY OF THE MEMBERS IN THE HOME HAVE DOG ALLERGIES? IF SO, WHICH MEMBERS? *
Your answer
DO ANY MEMBERS HAVE A FEAR OF DOGS? *
DO YOU HAVE ANY PETS CURRENTLY? IF SO, PLEASE LIST THE TYPE OF PETS AND THEIR AGES. IF NOT, PLEASE WRITE "NO PETS" *
Your answer
DOES ANYONE IN THE FAMILY HAVE EXPERIENCE TRAINING DOGS? IF SO, PLEASE LIST WHO AND WHAT EXPERIENCE (self trained a pet, attended training classes, competed in obedience or agility competitions, etc). *
Your answer
WHO WILL BE RESPONSIBLE FOR CARING FOR THE D.A.D.? WHO WILL THE DAD ALERT TO (DIABETIC, PARENT, ETC)? *
Your answer
DOES THE DIABETIC ATTEND EITHER SCHOOL OR WORK? *
Required
WOULD YOU EXPECT THE D.A.D. TO ATTEND SCHOOL, WORK, ETC. WITH THE DIABETIC? *
HOW MANY HOURS PER DAY WOULD THE D.A.D. BE LEFT ALONE? *
WHAT ACTIVITIES DOES THE DIABETIC PARTICIPATE IN? WOULD YOU EXPECT THE D.A.D. TO ACCOMPANY HIM/HER? *
Your answer
HOW MANY HOURS PER WEEK ARE YOU WILLING TO SPEND ON CONTINUAL TRAINING OF THE DAD? *
HOW OFTEN WOULD THE DOG ACCOMPANY THE DIABETIC IN PUBLIC *
Required
ARE YOU WILLING TO ACCEPT THE FINANCIAL OBLIGATIONS OF A D.A.D. - APPROX $1500/YEAR? (VET BILLS, INSURANCE, LEASHES, COLLARS, VESTS, PRIVATE TRAINER, GROOMING, ETC.) *
ARE YOU AND ALL FAMILY MEMBERS WILLING TO TREAT TO D.A.D. AS A WORKING DOG RATHER THAN A PET? (E.G. FOLLOW STRICT RULES REGARDING THE HANDLING OF THE D.A.D. - SUCH AS ONLY THE DIABETIC FEEDS THE DOG, NO EXCESSIVE PLAY BY OTHER FAMILY MEMBERS, ETC) *
HAVE YOU EVER HAD A SERVICE DOG BEFORE? *
D.A.D.S NEED EXERCISE EACH DAY. WHAT METHOD DO YOU PLAN ON USING TO EXERCISE HIM/HER? (Walking, running, fetch, treadmill, biking, etc.) *
Your answer
WHO WILL BE EXERCISING THE D.A.D. EACH DAY? *
Your answer
WE WILL DO OUR BEST TO TRAIN FOR NIGHT ALERTS, BUT NOT EVERY DOG IS CAPABLE OF THEM AND IT ALSO DEPENDS ON THE DOG'S SCHEDULE - DOGS NEED TO SLEEP TOO! DO YOU UNDERSTAND THAT NIGHT ALERTS CAN NEVER BE GUARANTEED? *
IF YOU HAVE A D.A.D., YOUR DIABETES WILL NEVER BE "INVISIBLE". YOU WILL GET MANY COMMENTS - GOOD AND BAD. SIMPLE THINGS SUCH AS GOING TO THE STORE CAN BECOME A HASSLE. ALSO BE AWARE THAT HAVING A D.A.D. IS MORE LIKE HAVING A TODDLER AND REQUIRES ATTENTION AND SUPPLIES NO MATTER WHAT THE CIRCUMSTANCES. ARE YOU COMFORTABLE WITH THIS? *
HAVE YOU RESEARCHED D.A.D.S AND WHAT THEY DO? IF SO, ABOUT HOW MUCH RESEARCH HAVE YOU DONE? *
PLEASE EXPLAIN WHY YOU WOULD LIKE A DAD AND WHAT GOALS YOU WOULD LIKE TO ACHIEVE BY HAVING ONE. FEEL FREE TO ADD ANY ADDITIONAL INFORMATION THAT WOULD ALLOW ME TO GET TO KNOW YOU BETTER, OR ANYTHING YOU BELIEVE IS IMPORTANT FOR ME TO KNOW. *
Your answer
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