Service Animal Registration

Last Name: *

If you do not qualify for a Service Animal we will issue a full refund of your purchase price. Please click "submit" below to complete the submission of your registration information. Thank You!!

Service Animal Registration

Has your dog been trained (by yourself or another competent individual) to assist you in alleviating your disability? *

Yes

Federal Law permits any individual who has a valid disability the right to have a Service Animal to assist them. You also have the right to train your own Service Animal. Using the information provided in the above evaluation our agency will determine if you are eligible for a Service Dog and Identification card issued from the UC Service Animal Institute.By signing you confirm the above information is true and correct *

Dog's Name: *

Please provide a brief explanation about how a trained Service Dog can help you? For example, Psychiatric Service Dogs can be trained to help their handlers by providing "tactile stimulation" by making contact with their owner during panic attacks, detect and prevent future panic attacks, awaken their handler from nightmares, search dark rooms/new environments for possible threats, and remind their handler when to take needed medications. *

Dog's Breed *

Email *

Please upload a picture of your Service Dog, we can crop the picture for you if necessary.

Have you ever been diagnosed with a disability? *

Yes

Phone *

First Name *

Mailing Address *

Service Animal Training and Registration

UC Service Animal Institute

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