Apply for an Assistance Dog

Please note the form is in three steps:
1. Essential requirements
2. Person Living With Dementia (PLWD) and Carer’s details
3. Your personal circumstances.

Carers, please confirm the essential requirements:

I care full time for a Person Living With Dementia (PLWD)

The PLWD and I live together in mainland Scotland (UK)

The PLWD has an early stage dementia diagnosis

PLWD Name and Surname

PLWD's age

Carer Name and Surname

Carer's age

Your Address (including postcode)

Carer Email

Preferred phone number

As the project relies on the carer being a central part of the dog partnership, can you (the carer) let us know about your general health?

Do you have a good support network around you? Please tell us about it.

Do you have a fenced garden?

Yes No

Does your household have any pets?

Yes No

If Yes, please tell us about them, please also feel free to include details of any pet dogs you have previously had:

What might you both enjoy about having a dementia dog living with you?

When was a diagnosis of dementia received? What type of dementia was it?

When did you first notice symptoms/changes?

I understand my data will be securely stored and processed by Alzheimer Scotland and Dogs for Good for the purposes of accessing this Dementia Dog service

Yes, I understand and consent.

About Assistance Dogs

Dementia Assistance Dogs are highly trained dogs, helping their family with specific tasks such as fetching medication pouches.

The dogs have full public access rights and live with the family at home, full time.

Please fill in the form with as much information as possible and we will get in touch with you within 8-10 working days.

Who can apply for an Assistance Dog

Please note the main criteria to be considered are that you live in mainland Scotland (UK), that you live at home with a full time carer and you have an early stage dementia diagnosis.

Apply for an Assistance Dog

About Assistance Dogs

Who can apply for an Assistance Dog

Dementia Dog Is a collaboration between
Alzheimer Scotland and Dogs for Good

Freshly woofed news
delivered quarterly.

Apply for an Assistance Dog

About Assistance Dogs

Who can apply for an Assistance Dog

Dementia Dog Is a collaboration between Alzheimer Scotland and Dogs for Good

Freshly woofed news delivered quarterly.

Dementia Dog Is a collaboration between
Alzheimer Scotland and Dogs for Good

Freshly woofed news
delivered quarterly.