Home » Service Dog Coaching Intake Form

Please Fill out Our Intake Form

We will get back to you in a timely fashion!

**It is your choice regarding what information you want to disclose.

**This information is being requested so Lee can help you to the best of his abilities and will be kept confidential within Wise Woofs. If you would prefer to discuss certain matters directly instead of on this form or simply keep it to yourself we understand and will work to meet your needs comfortably.

Name *

First

Last

Address *

City *

State *

Zipcode *

Phone *

Email *

Why do you want a service dog? *

What are you seeking Lee’s help for? *

Please describe your disability and how it affects you in the context of a service dog being able to improve quality of life?

Do you know what “tasks” you want your dog to be trained for? *

If yes, please list

Do you already have a dog selected for service work? *

If yes, please describe the dog and where it came from

Do you want help finding the right service dog for you? *

Have you owned a service dog before? *

If yes, please elaborate on your experience and how the dog impacted you

Please explain your experience with dogs in general *

How would you rate your own dog training abilities on a scale from 1-10?

Selected Value: 5