Intake form

Name *

Email address *

What type of letter do you need?

What is your primary reason for needing the letter?

Please select at least one option.

Housing

Travel

Emotional Support

Have you previously applied for a service dog letter?

Do you have a specific mental health condition?

Please select at least one option.

Anxiety

Depression

PTSD

Bipolar Disorder

What is your preferred method of communication?

Additional questions or comments

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