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Screening
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Registration
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Service Animal Questionnaire

Your answers are confidential and help our professionals determine your eligibility.

Confidential Screening

Your answers are confidential and used to help our licensed professionals and qualification system determine your eligibility. Please answer truthfully.

What type of animal do you have? *

Disability & Functional Background

These questions help determine whether you have a disability and how it affects major life activities relevant to service animal support.

Do you have a diagnosed physical, psychiatric, or neurological condition that substantially limits one or more major life activities? *
Are you currently under the care of a licensed healthcare professional for this condition? *
Does your condition interfere with daily activities such as working, studying, shopping, or social interaction? *
Does your condition cause medical episodes, panic, disorientation, or loss of stability that require assistance? *

Need for Assistance & Functional Support

These questions assess how your condition affects daily functioning and whether a service dog provides meaningful assistance or support.

How often do you require assistance or intervention when your symptoms arise? *
Does having your service dog accompany you help reduce or prevent symptoms related to your disability? *
Do you experience reduced independence or confidence in public without your service dog’s presence? *
Does your service dog help you manage or avoid medical or psychiatric emergencies? *

Task-Based Assistance

These questions assess whether your dog performs, or is being trained to perform, specific tasks that directly assist with your disability.

Does your dog perform trained tasks to assist with your disability (or is it currently in training to do so)? *
When prompted, does your dog reliably perform the trained task? *
Has your dog demonstrated the ability to perform its trained tasks in public environments without disrupting others? *
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