Get the free applicant-medical-history-form.doc - canineassistants

Applicant Medical History Form This form is to be completed by your physician and sent together with your other application materials to Canine Assistants. Information Release: Dr., Please release

How to fill out applicant-medical-history-formdoc - canineassistants

How to fill out applicant-medical-history-formdoc - canineassistants:

1. Start by gathering all necessary medical information: Before filling out the form, gather all relevant medical records, including any past illnesses, allergies, surgeries, medications, and vaccinations for the applicant.
2. Begin with personal information: The form will likely ask for basic personal information such as the applicant's full name, date of birth, address, phone number, and emergency contact details. Fill in this section accurately.
3. Provide comprehensive medical history: Enter the details of the applicant's medical history, including any chronic conditions, previous injuries or illnesses, hospitalizations, and major surgeries. Be as specific as possible and include all relevant dates.
4. Note any allergies or sensitivities: The form may ask about allergies or sensitivities to medications, foods, or environmental factors. Include any known allergies, their severity, and the type of reaction experienced.
5. Include current medications: List all current medications being taken by the applicant, including the name, dosage, and frequency. If there are no current medications, state "none" or "N/A."
6. Vaccination information: Provide details on the applicant's vaccination history, including the dates and types of vaccines received. This may include vaccinations for diseases such as rabies, distemper, or bordetella.
7. Sign and date the form: Once all sections have been completed, review the form for accuracy and completeness. Sign and date the form at the designated area to certify the information provided.

Who needs applicant-medical-history-formdoc - canineassistants:

1. Individuals applying for assistance dogs: The applicant-medical-history-formdoc is typically required for individuals who are applying to receive an assistance dog from Canine Assistants, an organization that trains and provides service dogs to people with disabilities.
2. Applicants with medical conditions: This form is especially relevant for applicants who have medical conditions that may impact their eligibility to receive an assistance dog. The form helps Canine Assistants assess the compatibility between the applicant's medical history and the potential service dog's capabilities.
3. Individuals seeking support for specific needs: Applicants who require support for mobility, hearing, or other specific needs can benefit from filling out this form. It allows Canine Assistants to determine the most suitable assistance dog match based on the applicant's medical history and the dog's training capabilities.

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What is applicant-medical-history-formdoc - canineassistants?

Applicant-medical-history-formdoc for Canine Assistants is a form for applicants to provide their medical history related to their eligibility for a service dog.

Who is required to file applicant-medical-history-formdoc - canineassistants?

Anyone who is applying for a service dog from Canine Assistants is required to file the applicant-medical-history-formdoc.

How to fill out applicant-medical-history-formdoc - canineassistants?

Applicants should fill out the form with accurate and detailed information about their medical history, following the instructions provided by Canine Assistants.

What is the purpose of applicant-medical-history-formdoc - canineassistants?

The purpose of the form is to assess the applicant's medical history to determine their eligibility for a service dog and to ensure the safety and well-being of both the applicant and the dog.

What information must be reported on applicant-medical-history-formdoc - canineassistants?

Applicants must report information such as medical conditions, medications, allergies, and any other relevant health information that may affect their ability to care for a service dog.