Qualification Document

Before you continue further, please make your payment, and upon the completion of the Questionnaires you will receive your Qualification Certification Document.

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SERVICE/SUPPORT ANIMAL QUALIFICATION
DOCUMENT QUESTIONNAIRE

ServiceAnimal.us has developed a process through which you are able to qualify for and receive a Service Animal Qualification Certificate. Please note that this Qualification Certificate is provided based on your own information, and is legitimized based on your assurance of its accuracy. This is not the same as the Qualification Certificate or document that you may receive from a licensed physician or mental health care provider. To receive a Qualification Certificate or document from a licensed physician or mental health provider, you can visit ServiceAnimalClinics.org

CANDIDATE QUESTIONS:

Candidate Name

Candidate Email

Candidate Phone #

Date Of Birth

Do you feel that your life will be improved by having a service/support animal?

What kind of service/Support does your animal provide?

Has your animal ever attacked any other animal?

Has your animal ever attacked any other individuals?

Could you provide medical documentations proving having this/these medical/psychiatric condition/s?

Is your animal completely safe around people and children and other animals?

Do you realize that only a specific animal is being Qualified by this evaluation, whose name and specifics are mentioned in this certificate?

Have you been diagnosed by a licensed professional with a medical or psychiatric condition that your dog is trained to provide services for??

Do you certify under penalty of perjury that you have provided, and continue to provide training to your dog to provide you with the appropriate services for your condition/s?

Can you gather the needed medical/psychiatric documents supporting the diagnosis of all your conditions for which your Service Animal is trained to provide the services?

Do you have any reservation receiving a Service/Support Animal Qualification Certification Document for you to have your animal with you in public places, around other people/animals, at your own risk?

Do you agree to hold ServiceAnimal.us, all its affiliates, associates, employees, consultants, contractors and anyone who is in any way associated with it, immune of any complaint arising out of the Service/Support Animal Qualification Document?

VERIFICATION

I hereby certify, under penalty of perjury, under the laws of all the States of the United States of America , and all the Federal Laws, that the above information is correct, and that I take full responsibility for my information, animal, all consequences of obtaining this document and its utilization.

Type Of Animal

Name Of Animal

Date Of Birth Your Animal

Age Of Your Animal

Color Of Your Animal

Breed Of Your Animal

Size Of Your Animal

The Services Your Animal Performs

Detailed Description Of Your Animal

VERIFICATION

I hereby certify, under penalty of perjury, under the laws of the State of California, that the above information is correct and I take full responsibility.