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Assistance Dog Information

By filling out this form, you are requesting more information about obtaining a service, therapy, or school facility dog from The Ability Center’s Assistance Dogs program. Completion of this form does not guarantee you will be matched with a dog.

Name*
First Name Last Name
Name of Parent (If a Minor)
Email*
Phone
Address*
Street Address Address Line 2 City State ZIP Code
Hidden
Date of Birth
Date of Birth*
MM slash DD slash YYYY
Disability Diagnosis*
How do you envision an assistance dog helping you?*
How did you hear about us?*
Phone
This field is for validation purposes and should be left unchanged.

Assistance Dog Information

The Ability Center

Bryan Satellite Office

Phone: 419-885-5733
Fax: 419-882-4813

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The Ability Center

Assistance Dog Information

The Ability Center

Bryan Satellite Office

Phone: 419-885-5733 Fax: 419-882-4813

Translate This Site

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The Ability Center

Phone: 419-885-5733
Fax: 419-882-4813