Join Our Waitlist! Are you looking for a Psychiatric Service or therapy dog? * Psych Service Therapy Please note that if you are looking for a therapy dog for an institution, school, or university, there is an alternate form to fill out. Please contact us directly at info@coastalcanines.org or call us at (760)230-3737 Are you looking to train a dog you already own? * Name of Primary Handler * First Name Last Name Age of Primary Handler? * What are your preferred pronouns? * If the Primary Handler is different from the Recipient, please provide the name and age of the Recipient, their qualifying disability, and ability or inability to self-manage a dog. * Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Character Reference and Phone Number * Do you rent or own your place of residence? * Are all members of your household in agreement with obtaining and training a service animal? * Yes No Don't know Have you and/or Recipient (if different) trained your own dog before? * Yes No Has Recipient ever been diagnosed with a psychiatric disability? * Yes No Are there any concerns you have bringing a dog into your home? * Any additional notes for Coastal Canines Thank you!
