Apply for a Dog

What is the general health of the dog? *

Very Good Good Just Okay Not Good

Please explain health of your dog: *

When are the yearly vaccinations and heartworm test given? *

How much did your dog weigh when you received him/her? *

What food and treats do you use? *

What is your dogs current weight? *

Does your dog eat rawhide bones? *

BEHAVIORAL QUESTIONS:

Do you feel that you have control of your dog? *

If you have any difficulties, when do they occur? *

Is your dog begging for food at the table? *

YES NO SOMETIMES

Is your dog eating off the ground and/or have his nose to the ground (floor) frequently: *

YES NO SOMETIMES

Describe your practice schedule (if active) and results. *

Is your dog performing the specific behaviors it was trained to do? *

YES NO SOMETIMES

Does your dog often refuse to respond to commands? *

YES NO SOMETIMES

How do you correct your dog? *

Additional comments, stories, etc that you would like us to know: *

Please explain when and to which commands: *

Does your team need more training? If so, please explain: *

DOCUMENTATION:

Please attach, mail, email, or fax a copy of your dog’s most recent health records to add to your dog’s file. This includes any records that your veterinarian has provided you when you go to regular appointments. ADI standards require us to obtain this information on a yearly basis.

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

ASSISTANCE DOGS OF THE WEST
2017 CLIENT ANNUAL SURVEY
Please complete the following survey and attach the appropriate documents.

This required communication is to help ADW make certain you and your dog are still a well functioning team and to keep accurate ADW records of your and your service dog.

GENERAL QUESTIONS:

QUESTIONS ABOUT THE DOG:

BEHAVIORAL QUESTIONS:

DOCUMENTATION:

ASSISTANCE DOGS OF THE WEST 2017 CLIENT ANNUAL SURVEYPlease complete the following survey and attach the appropriate documents.

This required communication is to help ADW make certain you and your dog are still a well functioning team and to keep accurate ADW records of your and your service dog.

GENERAL QUESTIONS:

QUESTIONS ABOUT THE DOG:

BEHAVIORAL QUESTIONS:

DOCUMENTATION:

ASSISTANCE DOGS OF THE WEST
2017 CLIENT ANNUAL SURVEY
Please complete the following survey and attach the appropriate documents.