Download and print this Medical Form to be filled out by your Physician or Therapist.  They must mail the completed form to:

Parrots for Patriots Emotional Support Dogs

13215 SE Mill Plain Blvd. C-8 # 101

Vancouver, Washington 98684

www.parrotsforpatriots.org

*We maintain confidentiality of our clients’ records.  What you write here will not be shared with your patient unless you give express permission.