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It is now Open Enrollment 2024 into Dixies Dogs with Purpose service dog program. To start the application process please submit both parts of the application below. Please allow 2 weeks for your application to be reviewed.

Service Dog Application

Medical Information

If you are applying for a PTSD or Anxiety service dog and have physical limitations, we must know what your physical needs are in order to match the best possible decision for your needs.

Are you Right or Left handed?
Which side would you prefer your service dog be taught to work from?
Verbal Skills: On a scale from 1 (non-verbal) to 10 (fluent with clear annunciation) rate your quality of verbal communications
Do you have difficulty getting out of bed?
If Yes, what side of the bed do you sleep on?
Do you have difficulty waking in the morning?
Do you have difficulty getting dressed?
Previous Medical History
Adaptive Equipment Used
If you use multiple types of adaptive equipment, which is your preference for the dog to work off of?

Symptomology Experienced complete this section for psychiatric issues

For each Item on a scale of 1(does not limit function) to 10 (fully limits function) answer each of the following:

Social and Athletic Activities

This completes Part One of the service dog application, Please select submit and continue to Part Two below

Please contine to Part two to continue your application. Applications missing part two will not be processed

Service Dog Application Part Two

Vocational

Are you presently Employed
Full Time or Part Time
If you are not employed, do you plan on becoming employed?
Are you currently enrolled in school?

Household

Final Questions

Thanks for submitting your application, please allow 2 weeks to review your application!

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