Serving Upstate New York since 2007
30 Railroad Ave, Albany, NY
(518) 831-9192
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Diane Blackman, CPDT-KA, IACP-PDTI/CDTA, CTDI
LuAnn Charbonneau
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Service Dawg Evaluation
Service Dawg Evaluation
Service Dawg Evaluation Registration
Please complete the following form to register for our service dog evaluation. We look forward to working with you and your dog!
Date
*
Date Format: MM slash DD slash YYYY
Client Name:
*
First
Last
What tasks would you like your service dog to perform for you? (Check all that apply but AT LEAST three tasks).
*
Please
click here
to view task descriptions.
Select All
Balance Assistance
Blocking
Bracing
Call for Help
Grounding
Opening & Close Doors/Drawers
Pull wheelchair
Press automatic door switch
Retrieving Items
Turn on/off light switches
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone:
*
Cell Phone:
*
Email
*
Enter Email
Confirm Email
How did you learn about All Dawgs?
*
Event
Referral
Returning Client
Social Media
Web Search
Other
Who referred you to All Dawgs?
*
Friend
Rescue/Shelter
Pet Store
Vet's Office
Please list your friend's first and last name so we may thank them.
*
What's the name of the vet hospital that referred you?
*
What Shelter or Rescue Organization referred you?
*
Which Pet Store referred you?
*
Would you like to receive our e-newsletter?
Yes
No
What is the name of your vet hospital?
*
Dog Information
Dog's Name
*
Dog's Date of Birth
Date Format: MM slash DD slash YYYY
Put best guess if adopted
Dog's Breed
*
Dog's Gender
*
Female - Intact
Female - Spayed
Male - Intact
Male - Neutered
Is your dog on a restricted diet?
*
Yes
No
We will test your dog for food guarding issues. Since your dog is on a restricted diet, you are required to bring 10-13 ounces of WET dog food that your dog may eat. If you do not bring this food, we will be unable to hold this evaluation. A new evaluation, including a new evaluation fee, will be required if this happens. Please initial that you understand this added requirement.
*
Please tell us anything else that will aid in us training this dog for your use as a service dog:
By initialing this box, you acknowledge you will have the dog have OFA x-rays after his/her second birthday at your own expense to confirm the dog is physically able to perform this task. All Dawgs is to receive the results the OFA certificates before this task training will commence. This task will not be taught if this dog does not receive OFA certification of "Good" or "Excellent."
*
By initialing this box, you acknowledge you will be responsible for the purchase of the K9 Rescue phone system.
*
By initialing, you acknowledge that All Dawgs records all service dog evaluations for the purpose of potentially developing a service dog contract with you. You waive any and all rights to this recording.
*
By initialing this box, you acknowledge that you understand there is a no cancellation policy for any aspect of Service Dawg training (including but not limited to the evaluation and private lessons.) This includes reschedules.
*
By initialing this box, you acknowledge that you understand that the results of this evaluation will be valid for 90 days. If you do not enter into a contract within that time, a new evaluation will be required for an additional fee.
*
By initialing this box, you affirm that the above information is accurate to the best of your knowledge
*
Email
This field is for validation purposes and should be left unchanged.