Client Application

Please fill out this entire online application along with:

– Sealed letters of reference and diagnosis from each of your physicians, therapists, and counselors stating that your disability is work related or service connected and that a service dog is medically necessary and will be beneficial to you.

– Please provide a CORI on yourself and include it with your application packet.

– Applicants who have been discharged from the military must provide proof of honorable discharge and a copy of their DD214 form.

– Include a letter of recommendation (from a non-family member).

Mail the entire completed application to BASK, 4 Main Street, Unit E, Medway, MA 02043

 

Please also specify city and state of employment/school
If yes, please list
if applicant's only disability is PTSD, please skip this question
if applicant's only disability is PTSD, please skip this question
if applicant's only disability is PTSD, please skip this question
if applicant's only disability is PTSD, please skip this question
if applicant's only disability is PTSD, please skip this question
Name, Age, Relationship
Name, address, phone and email
If yes, please list the age, sex, and status of neutered of the dog(s)
Name, address, phone
Complete this question if your PTSD is a result of military service
Complete this question if your PTSD is a result of military service
Complete this question if your PTSD is a result of military service
Complete this question if your PTSD is a result of military service
Complete this question if your PTSD is a result of military service
Complete this question if your PTSD is a result of military service
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Complete this question if you are diagnosed with PTSD
Current and Last, address, and dates lived