How did you hear about TBI Seizure Alert and Recovery GIANTS?
Name: (Last, First and Middle initial)
Any nicknames you would prefer to be called:
Home address:
Contact phone number:
May we leave a voicemail or message:
Yes or No
Email:
Male or Female: We ask this question because we have dogs that tend to adapt better to one sex over the other.
Occupation: (Please de note if you are a student and where you attend, also reference if you are currently retired or unable to work)
If you have an occupation or am a student, will your dog be able to be with you at work or school?
Once approved for a service dog, will TBI Seizure Alert and Recovery GIANTS, be given permission to contact your school or employment for training purposes? YES or NO
Please be aware that your dog's last 3 weeks of training is intense and you must attend a 3 week training program with us. This can be arranged to fit the needs of the handler and the dog. Will you be willing to attend a 3 week training program? YES or NO
Are you regularly hospitalized for any period of time? If so, do you have a dedicated caregiver for your dog?
What is your level of activity and do you require an assisted device for walking/ wheelchair? If you have a wheelchair is it manual or electric?
What are your hobbies or personal interests?
Would you be interested in participating in local, state or national walks for either brain injury awareness or national epilepsy associations?
Is this your first dog? Do you have other pets? If so, what type?
Are all pets in your home either spayed or neutered?
YES or NO
Are all members of your household aware of your application for a service dog?
Can we interview the family about having a service dog?
Do any of your family members in your home have a dog allergy?
Who will be the primary caregiver for your service dog?
Does your family regularly take vacations? If so, to where and how often?
Do your travel plans include the inclusion of your service dog?
Do you live alone or with another person? Do you have children? If so, what are their ages?
How many adults live in the home? Please include name, relationship and age.
Type of residence: i.e. Apartment, House, Mobile Home, Assisted Living, With Parents, etc.
Are you currently renting or do you own a home? If neither applies to you, please describe your living situation.
How long have you resided at your current address? How long do you plan to maintain this address?
If applicable, name of landlord and phone number. We will only contact when we are ready to place a service dog.
Do you have a dog breed preference? Do you have experience with any particular GIANT breed?
What type of floors do you have in your home? Ex: hardwood floors, carpeted, stone floors, etc.
Will your dog have access to a fenced yard? If so, can a doggie door be installed?
Care and Maintenance
Are you aware that your service dog will need exercise and play that is not a part of their daily work schedule as a service dog? If so, please describe how you would make this happen?
Will you follow established feeding guidelines (including type of food) and regular vet vaccinations protocol including daily vitamin schedule, flea and tick preventatives and heartworm preventative schedules?
Info: All of our Service Dogs are on a large breed Science Diet and Eukanuba. They also consume â…“ pound cooked ground beef a day along with one teaspoon of coconut oil. They are all on Nexgard and Interceptor as well as cosequin and probiotics. All of these products can be easily purchased through Chewy. The amount of dog food consumed, varies from dog to dog. Diet is one of the most important factors to a good working service dog.
TBI Seizure Alert and Recovery GIANTS requires all dogs to be microchipped and that information must solely be registered with us and we must also have full access to all vet records at all times and also must have the right to make random vet inquiries. Please be aware that we require annual service dog checkups that include a report to be completed by your vet and a copy to be sent to us. Are you willing to agree to this provision?
YES or NO
REFERENCES
Current Veterinarian or one you plan to use and can we contact them:
Name, Phone and address
If you live in the Topeka area, we prefer you work with North Topeka Animal Hospital as they are our Service Dogs preferred provider.
Personal References ( Please include 3)
Name, Relationship, phone number and email. Can we contact them?
Thank you for interest in TBI Seizure Alert and Recovery GIANTS! We look forward to reviewing your questionnaire answer. We will contact you shortly, usually within 30 days about the next step in service dog training!!! Please either email or mail the completed questionnaire to us to the addresses listed at the top of the questionnaire.
PAWS UP!!
TBI Seizure Alert and Recovery GIANTS