Embrace A Vet, Inc. · Paws for Peace Application

Contact Information

Name

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First Name

Last Name

Name of Spouse

First Name

Last Name

Email

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Phone

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Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

County

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Where did you hear about us?

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Date of Birth

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(mm/dd/yyyy)

Do you have a service-connected diagnosis of PTSD and/or Traumatic Brain Injury (TBI)?

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What branch did you serve?

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Do you have a dog you would like to use as a potential service dog?

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Please list the gender, age, and breed of the dog:

Are you interested in Embrace A Vet pairing you up with a suitable dog to be a potential service dog?

A service dog requires considerable training, ideally together with you from the start. Are you interested in participating training your dog?

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Are you able to financially care for a dog, i.e. food and veterinary service if needed?

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Are you able to exercise a dog, i.e. walking/biking/running?

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Other than PTSD and/or TBI, are there any physical or mental health issues and/or limitations we should know about?

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Briefly describe your living situation, i.e. house, apartment, available yard, fenced in?

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Are there any other people or family members living with you? Please list and provide ages of any children.

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Please list any other animals/pets/livestock:

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Do you have any other special requirements? If yes, please specify.

Download Referral Form

Click here to download our Paws for Peace Referral Form. Please have your mental health provider fill it out and submit along with DD214.

Please Read:

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Please understand that your application will not be processed until it has been completed and furnished with your supporting documents, your Referral Form (link below) and a copy of your DD214. Also please note that at this time we are only serving veterans who are current Maine residents.

Yes, I have read this and understand