PSD Questionnaire

PART A: PERSONAL DETAILS - Step 1 of 6

If you want to qualify for a psychiatric service dog letter, we will connect you to licensed mental health practitioners who will review your condition. But the first step is filling out our questionnaire. We will ensure the information you provide is kept confidential.

Your Official Legal Name *

First

Last

Gender *

Confirmation 18 years old *

I confirm I am at least 18 years old and not acting on behalf of anyone else. *

Date of Birth *

Must be an adult 18+

Email Address *

Confirm Email

Phone Number *

Do you want to own a psychiatric service dog? *

NOTE: A PSD can only be a dog and no other type of animal. Also, the PSD should be well trained to help you perform specific tasks limited by your disability.

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Have you experienced any mood swings or changes in the last 6 months? *

Have experienced any of the following symptoms in the last 6 months

Fatigue
Extreme anger or irritability
Depressed or elated mood
Restlessness
Changes in sleep patterns
Muscle tension
Suicidal thoughts
Wanting to hurt others
Not interested in performing activities you once enjoyed
Sudden weight gain or loss
Sudden increase or loss of appetite
Unable to make a clear decision
Isolation and feeling lonely
Performing poor at school or work
Feeling sad
Other
None

Have of you been feeling sad or depressed *

If yes, how long for the symptoms persist? *

Less than 1 hour
1-3 hours
3-5 hours
Greater than 5 hours

Do you often feel anxious?

If yes, for how long do you feel anxious? *

Less than 1 hour
1-3 hours
3-5 hours
Greater than 5 hours

Does feeling anxious and depressed interfere with everyday life activities such as sleeping, eating, working, and speaking?

Major Life Activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

If yes, how do the symptom affect normal life activities?

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Have you in experience any traumatic life events? *

If yes, have you experienced any of the following symptoms due to a past traumatic event?

Other
Dreams about the traumatic events
Flashbacks
Avoiding remembering the negative aspects of the event
Difficulty in recalling essential aspects of the vent
Negative feelings about yourself
Not feeling to associate with others
Difficulty in feeling happy
Self-destructive behavior
Easily angered
Others specify

In the last three months, how have the traumatic events bothered you?

Rarely
Moderately
Very Often
Other

Do the symptoms of traumatic events affect your everyday activities, such as eating, sleeping, working, and walking, among others?

If yes, how have the symptoms affected your everyday life activities?

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Have you experienced any intense fear or anxiety for no apparent reason? *

If yes, how often do you experience intense fear or anxiety?

Daily
Several times a week
A few times per month
Never
Other

Are you afraid of having anxiety and panic attacks in the future?

During the last anxiety and panic attack, did you experience any of the following?

Increased heart rate
Uncontrollable shaking
Dizziness or nausea
Difficulty breathing
Hot flashes or profuse sweating
Numbness of extremities (legs, fingers, toes, etc.)
None of the above

Do the anxiety or panic attacks interfere with everyday life activities such as sleeping, walking, and eating?

If yes, how does it affect your everyday life activities?

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Have you been diagnosed with any psychological or physical disorder in the past? *

If yes, were you given any medicine, and how long have you used them?

Kindly share anything else you wish with the licensed mental health practitioner.

Animal Name: *

Animal Type: *

Animal Breed: *

Animal DOB: *

Animal Weight: *

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Discount Code

Please enter your redemption code

OUR PSD LETTER *

Price - $149.00

OUR PSD LETTER (100% OFF) *

Price - $0.01

OUR PSD LETTER (10% OFF) *

Price - $134.10

OUR PSD LETTER (97% OFF) (copy) *

Price - $2.00

OUR PSD LETTER (99% OFF) *

Price - $0.05

OUR PSD LETTER (85% OFF) *

Price - $23.85

OUR PSD LETTER (15% OFF) *

Price - $126.65

OUR PSD LETTER (20% OFF) *

Price - $159.20

OUR PSD LETTER (25% OFF) *

Price - $149.25

Automatic Annual Renewal

You should opt for the Automatic PSD Letter Renewal at a discounted rate of 125.00$

By opting for the automatic annual renewal service, we will automatically renew your letter at a discounted rate of $ 125 rather than a standard fee of $ 199. The service is optional, and we will inform you when it is time to update your information.

Automatic Annual Renewal (10% OFF)

You should opt for the Automatic PSD Letter Renewal at a discounted rate of 112.50$

By opting for the automatic annual renewal service, we will automatically renew your letter at a discounted rate of $112.50 rather than a standard fee of $ 199. The service is optional, and we will inform you when it is time to update your information.

Automatic Annual Renewal (15% OFF)

You should opt for the Automatic PSD Letter Renewal at a discounted rate of 106.25$

By opting for the automatic annual renewal service, we will automatically renew your letter at a discounted rate of $106.25 rather than a standard fee of $ 199. The service is optional, and we will inform you when it is time to update your information.

Automatic Annual Renewal (20% OFF)

You should opt for the Automatic PSD Letter Renewal at a discounted rate of 100$

By opting for the automatic annual renewal service, we will automatically renew your letter at a discounted rate of $100 rather than a standard fee of $ 199. The service is optional, and we will inform you when it is time to update your information.

Automatic Annual Renewal (25% OFF)

You should opt for the Automatic PSD Letter Renewal at a discounted rate of 93.75$

By opting for the automatic annual renewal service, we will automatically renew your letter at a discounted rate of $93.75 rather than a standard fee of $ 199. The service is optional, and we will inform you when it is time to update your information.

Expedited Service - Rush Digital Delivery

Rush Digital Delivery service at - $49.50