Seizure Response Dog Guide Expression of Interest

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First name *

Last name *

Have you reviewed the program discovery package in full? *

Yes
No
I'm not sure

Thank you for your interest in our program

Before continuing, please review our Discovery Package with all you need to know about the program. Click here for further details.

Do you have a medical diagnosis of intractable epilepsy (not able to be controlled by medication)? *

Thank you for your interest in our program

Unfortunately, you do not meet the criteria for our program. For further information on what our Seizure Response Dogs do, please refer to our Discovery Package.

Age of applicant *

Thank you for your interest in our program

Unfortunately, you do not meet the criteria for our program. For further information on what our Seizure Response Dogs do, please refer to our Discovery Package.

Legal guardian's name

Province or territory of residence *

What is your preferred language? *

English
French
I am bilingual in English and French

Contact email *

Contact phone *

Thinking about the last 4 weeks, how many seizures have you experienced? *

When you experience a seizure, do you exhibit consistent physical movement? *

Please list any other physical or medical conditions: *

As explained in the Discovery package, our Seizure Response Dog Guides need to be the only dog in the client’s home. If you currently have a dog, would you be able to rehome the dog if you were accepted into the program? *

Will the Seizure Response Dog Guide reside in a smoke free environment? *