• Please review the application instructions before completing this form. Your application will be reviewed and a meeting scheduled when all information has been received. Part A - Client Application, completed by client, Part C a Video of your home and environment (still photos are fine if providing a video is difficult), two letters of recommendation and a $25.00 application fee. Additional paperwork will be required to be completed for specific disabilities. Part B - Medical Form, completed by your physician or therapist, describing your disability. Paws for Life USA will keep your entire application confidential. Your video and written application will become the property of Paws for Life USA.
  • 1 being NO USE--------- 10 being FULL USE
  • Write the number between 1-10 in the space provided.