Now Accepting Preliminary Applications

Please read before submitting the Preliminary Application:

Confidentiality Agreement

Client Expectations

SMSD Grievance policy

It is our policy that Veterans who apply must have a service connected PHYSICAL DISABILITY that is verified and rated by the VA. Physical disabilities include loss of limb, injuries sustained during training accidents or while deployed, systemic disabilities due to exposure to toxic substances, TBI and more. There are injuries where canine mobility assistance is appropriate. SMSD does NOT train dogs for PTSD UNLESS the veteran has a service connected physical disability in addition to their psychological disabilities. SMSD serves Veterans only. We do NOT train dogs for general disabilities, seizure or diabetic alert, or guide dogs for sight problems.

In addition, our normal service area is a 350 mile radius or an approximate 6 hour drive from Knoxville, Tennessee. SMSD serves the entire state of Tennessee and portions of Alabama, Georgia, North and South Carolina, West Virginia and Virginia regionally. Please note that we do have the ability to OVERRIDE the service area with SMSD board approval when the applicant meets the application criteria and is approved by the SMSD application team. For more information about our application process and how we operate, please read the frequently asked questions.

Please provide the following information:

Name:
Address:
City:
State:
Zip:
Phone:
Email:
Name of Veteran applying for service Dog:
Age:
Height:
Weight:
If not the veteran, name of person completing this form and relationship to the veteran:
Military Service:
Branch:
Service Start:
Service End:
Rank at Discharge:
Type of Discharge:
Please list your service connected physical disabilities:
Please describe how your physical disabilities affect your daily life:
Do you have a service connected psychological disability such as PTSD?:
Please describe how your psychological disabilities affect your daily life:
Please explain why you feel a service dog would be helpful:
Please check items you currently use for mobility assistance:
Cane
Walker
Wheelchair
Motorized chair or scooter

AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

Please click below and read the details of this disclosure before signing authorization.

Authorization for Use or Disclosure of Protected Health Information

I voluntarily authorize release of my confidential protected health information for use by SMSD Application team as needed to determine my eligibility for a service dog as required by their application criteria. I have read the details disclosed on the link provided. This authorization expires in one year from the date below.

Signature (type your name)
All applicants are considered regardless of race, color, religion, marital status, sex, national origin, age, or sexual orientation.


Upon receipt of this information, you will be contacted by Smoky Mountain Service Dogs, either by email or telephone for a Preliminary Application Review/Discussion.