Confidential Clinical Screener

Psychiatric Service Dog (PSD) Evaluation

Evaluated by state-licensed mental health professionals for ADA Title II/III and DOT air travel accommodations.

1. Dog's Name & Breed

2. Which disability-mitigating tasks does your dog perform or is being trained to perform? (Select all that apply)

Deep Pressure Therapy (DPT) Grounding during panic attacks Waking handler from night terrors Crowd buffering / personal space Interrupting repetitive/harmful behaviors Medication reminders & alerts

3. Primary Mental Health Symptoms / Conditions

4. State of Residence (for clinician matching)

5. Handler Information

✓ 100% Money-Back Guarantee if unapproved by evaluating clinician.

✓ DOT Air Carrier Access Act travel certification documentation included.

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Psychiatric Service Dog (PSD) Evaluation

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