The Application

To inquire about our service dogs or to request a preliminary application packet, please complete the following questionnaire

First name

Last name

Street Address

State

City

Phone

Relationship to person needing dog

Name of person needing the dog

Birthday of person needing the dog

Dog Allergies Yes/No

Primary Diagnosis

Only one Scent Trained task is allowed (Seizure Detection OR Diabetic Alert or POTS detection

If the service task you are interested in was not included in the drop down list - please add it here

How do you envision a service dog helping or assisting you/the handler

Do you have social media? if yes please provide info

Anything additional you would like to share

I unerstand Loyal Companios will not train my pet dog as service dog

If I am NOT 21 years of age - I understand I will need a parent/gardian complete the application packet and contract.

Thank you! We’ll be in touch.