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First name

Address

Phone

Email

Employment Status

Do you have a dog that you would like to be evaluated to be a Service K9?

What is your dog's breed?

How old is your dog?

What is your dog’s name?

Are you an active or retired member of the Military Service or a First Responder?

Please provide answers to the following so that we can assess your situation:

Why do feel you require the aid of a service dog? (Select all that apply)

Tell us about the person who will be working with the service dog including any prior experience with K9’s:

Is there any medical condition or medications that we would need to be aware of during your training?

A medical referral form will be required, will you be able provide this from your medical practitioner? (the form will be provided)

Does your current living situation allow you to afford and accommodate a service K9? (we will require a home visit prior to placement of the service dog)

Do you have other pets residing in the home? (Please describe)

Do you have concerns or questions about leasing a Complete K9 Service dog?

Registration Form

Complete K9 Ltd.