Client Update Form Step 1 of 4 25% Name* First Last Email* Help us update our recordsDo you wish to remain on the PADS waitlist?* Yes No What reasons influenced this decision*Check any/all that apply Wait was too long Received a dog from another agency Needs have changed Have changed my mind Other If "Other" please feel free to provide additional information: Thank YouThank you for letting us know why you are no longer interested in receiving a dog. Contact InformationMy address or contact info has changed Yes No Address & Contact InfoIf you have moved or your contact info has changed in any way, please complete the applicable sections. Address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone 1Phone 1 TypeHomeCellWorkPhone 2Phone 2 TypeHomeCellWork About youWhat kind of PADS dog are you awaiting: Service Dog Hearing Dog Accredited Facility Dog Has your living situation changed?*For example have you moved from a house to an apartment, etc? Has there been a change in family members, roommates, pets? Yes No Please describe how your living situation has changed (please describe in detail: roommates (ages/relationship/etc), pets (type, breed, age, etc), living situation (house/apartment/condo, fenced yard, etc):*Have your needs changed since you last updated PADS?* Yes No How my needs have changed (Hearing Dog)Please describe how your needs have changed.For example, are there new sounds, environments, etc.How my needs have changed (Accredited Facility Dog)Please describe how your needs have changed.For example, are there new sounds, environments, etc.How my needs have changed (Service Dog)Please complete the following questions to give us a sense of your physical abilities and limitations. I can pick up items off the floor Always Often Sometimes Never I can pick up items off a chair Always Often Sometimes Never I can pick up items off a table Always Often Sometimes Never I can push elevator buttons Always Often Sometimes Never I can pick up items off a table Always Often Sometimes Never I can turn On/Off light switches Always Often Sometimes Never I can open drawers and cabinets Always Often Sometimes Never I can push my manual chair Always Often Sometimes Never Not applicable I can lift my arms Always Often Sometimes Never I can walk / ambulate Always Often Sometimes Never Additional InformationIs there anything else you'd like to share about how your needs have change?*CAPTCHA
