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Psychiatric Service Dog Assessment

Prepare information for an individualized professional evaluation. A letter does not replace disability-related task training.

Local preview: use test information only. Your answers stay on this page and are not submitted.

  1. 1 · Assessment
  2. 2 · Your information
  3. 3 · Review
0 of 16 questions answered
1What specific tasks does your dog perform to help with your disability?

Select all that apply. Comfort from a dog’s presence alone is different from a trained disability-related task.

2How were these tasks trained?
3Describe how your dog performs each task, step by step. Please enter at least 20 characters. Do not include someone else’s personal details.
4How reliably does your dog perform these tasks?
5Can your dog accompany you in public without disruptive behavior?

Task training evidence Optional

You may choose a file or add a link to illustrate training. Files are not uploaded in this preview.

6How long has your dog been performing these tasks for you?
7How often do you experience emotional distress, anxiety or depression?
8Which experiences would you like to discuss with the professional?
9Have you experienced a major life change affecting your mental health?
10How often do symptoms interfere with daily life, work or responsibilities?
11Are you currently taking prescribed medication for mental health?
12Have you received a mental health diagnosis from a licensed professional?
13Are you receiving mental health treatment or therapy?
14In your own words, how does your dog help you manage disability-related needs? Please enter at least 20 characters. Do not include someone else’s personal details.
15What type of housing do you currently live in?
16Are you currently having thoughts of harming yourself or others?

This form is not monitored for urgent help. If you are in immediate danger, contact local emergency services.

Learn about ADA service animal requirements. Housing and airline rules can differ.