Application form

Apply to get a guide dog.

Mira Header Chien Guide
All fields are required, unless otherwise mentioned. Step 1 of 3

Guide dog request

Medical Report

Notice: To be eligible for the guide dog program, you must first complete the medical report.

Please download the PDF form below and have it filled out by your doctor. You can then submit the completed document and proceed with your request.

Download the medical report (PDF)

Submit your completed and signed document here

Please send the medical report to