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Assistance Dog Placement Service

This form is specifically for those looking to locate & or purchase a service dog, emotional support dog or a therapy dog. If you want to register or train your own dog click here instead By filling out this form you understand this information will be transmitted throughout our network of trainers and other organizations that specialize in the placement of service dogs, emotional support dogs and therapy dogs. There is a small one time for this service. We can not guarantee you will obtain the result you desire. You agree to be contacted using the information provided by you below by organizations that feel they can assist you.

Make A Selection*
- I Have A Dog I Want To Train
- I Want To Purchase A Dog
Select The Type Of Dog*
Select What Best Describes Your Needs*
- Medical Alert Dog
- Diabetic Alert Dog
- Physical Assistance Dog
- PTSD Assistance Dog
- Allergy Alert Dog
- Autism Assistance Dog
- Brace / Mobility Assistance Dog
- Hearing Assistance Dog
- Medical Assistance Dog
- Psychiatric Service Dog
- Seizure Assistance Dog
- Visual Assistance Dog
- Wheel Chair Assistance Dog
Select What Best Describes Your Needs*
- Adjustment Disorders
- Generalized anxiety disorder
- Social anxiety disorder
- Phobias
- Panic disorder
- Post-traumatic stress disorder
- Separation anxiety
- Dissociative Disorders
- Factitious Disorders
- Eating Disorders
- Impulse-Control Disorders
- Mental Disorders
- Neurocognitive Disorders
- Mood Disorders
- Neurodevelopmental Disorders
- Personality Disorders
- Psychotic Disorders
- Sexual and Gender Identity Disorders
- Sleep Disorders
- Somatoform Disorders
- Substance Related Disorders
- REASON NOT LISTED
Your Name*
First Last
Your Address*
Street Address Address Line 2 City State ZIP Code
Your Phone*
Your Email*
Describe Your Home
Is Your Home Fenced?
- Yes
- No
Describe Your Disability*
Describe Your Typical Day
What Type Of Dog Are You Looking For?*
If you are looking for a certain size of do or breed explain below.
How Can This Dog Help You*
What Is Your Budget For A Service Dog?*
Assistance Dog Location Network Activation Fee*
This service requires a one time activation fee. Once activated you will be eligible to be contacted by organizations that fit your needs based on your profile.
- One Time Activation Fee Using A Credit Card 25.00
- One Time Activation Fee Using PayPal 25.00
Credit Card

Card Details

Cardholder Name
One Time Charge Due Now
$0.00

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