Generating Effective Patient Referrals for a Service Dog (SD)

This months article seeks to provide information to healthcare professionals, in an effort to assist them in making referrals for patients seeking SD assistance.

First, it is important for all providers to understand the difference between a companion (emotional support) animal, a therapy dog and a SD.

  • Emotional support animal (ESA) – an animal, canine or otherwise, whose function is too provide companionship to an individual.
  • Therapy dog – traditionally this is a dog trained to visit patients in therapeutic settings such as hospitals and nursing homes.
  • Service dog – a dog that has been individually trained to do work or perform tasks for a person with a disability.

It is our experience that most confusion arises when making the distinction between an ESA and a SD.  It is the task specific nature of the training that distinguishes the difference between these two groups.

Tasks must be discernible.  This means that one must be able to measure them.  When the FSDS undertakes certification testing, we require a patient to list at least three tasks that they require assistance with.  They are listed on the test paper.  The Evaluator must be able to witness the dog performing these tasks on command.  For example, “makes me feel secure” and “makes me happy” are not tasks, as these can not be measured.  Retrieving dropped objects, and correctly identifying high and low blood sugar samples are discernible tasks.

When considering a SD for a patient, several factors must be considered:

  • In the case of a diabetic patient, has the patient been compliant with current treatment regimens, and have attempts to manage their diabetes with lifestyle modifications (ie: dietary management) and medications failed?
  • Does the patient have limited mobility, and will provision of a SD with a balance and support harness help to keep the patient mobilized, preventing the negative consequences that accompany a sedentary lifestyle?
  • Will provision of a SD improve clinical outcomes and help to reduce the overall cost associated with care for this patient if you are able to prevent some hospitalizations and crisisi ER visits?
  • Will provision of a SD mitigate disabilities, and help to keep the patient engaged in their current activities?

All patients are not good candidates for a SD.  A suitable candidate must be:

  • in a stable living arrangement
  • able to provide for ongoing care of the dog
  • compliant with current management plans
  • able to demonstrate the emotional stability required of a team leader
  • able to safely participate in the training process

Referral Do’s and Don’ts:


  • Maintain a list of credible training programs in your area, so that you can provide written information to patients.
  • Maintain a stock of any required forms that you will have to complete, and keep them on hand in your office; this way the patient can get any forms required at the time of the referral and not have to make additional trips back to your office.
  • Educate your staff on what types of tasks a SD can and can not perform


  • Write a prescription, a referral from a physician for a SD is a suggestion, not a doctors order.
  • Sign any statements indicating that a particular dog is a SD and can be with the patient in public – this is a liability risk for you.  Simply provide a statement (or sign the program issued form) indicating that the patient has a disability that meets the ADA definition and would benefit from the assistance of a SD.  Then refer to a credible training program.

Given the current problem with fake SDs in the community, and the risks that this poses to public health and safety, it is more important than ever for our front line health providers to be well-versed in SD rules, and to provide accurate information to patients.

Classroom News

Despite the ongoing challenges of the pandemic, we are pleased to report that the training remains on track for all of our students.

Keeta & Dani– are working on generalizing  service tasks such as go get help, picking up items and retrieving the medicine bag from different locations. Dani will hopefully meet her recipient this coming month.  The FSDS always reserves one to two dogs for those late applications from wounded military and first responders.

Henry & Solomon– Solomon was neutered this past month (as are alFSDS dogs at 15 months of age) and is eager to get back to work. The team is working on getting Solomon to nudge Henry on his leg instead of the lid to alert Henry to different sounds as needed. We are still in the beginning stages, but Solomon is making progress with generalizing the “touch” command to perform this alert task.

DeAnna & Scooby (and recipient Tesia)  are doing great with continuing involve the recipient more with the training process.   Scooby has mastered walking next to the grocery cart with Tesia and remaining at heel side. We are also working on “go get help” and generalizing the “touch” command to translate this into medical alert tasks.

Brain & Mando continue to work on their scent training.  We are starting to introduce the “paw” command to get Mando to “paw” on Brian’s legs on command and then eventually eliminate the command and have Mando do it on his own. They have also been working on training around distractions such as unfamiliar dogs.

Tina & Socorro are building up their sound library and having Socorro alert Tina to new sounds both inside and outside of the home.  They have also been working on basic commands at a park in their neighborhood to practice generalizing commands into the public space.

Soyini & Coco– just moved into a new home, and are introducing basic commands such as place, sit/down stays, touch, loose leash walking around the neighborhood.   They continue to work on tasks such as retrieval of the medicine bag and go get help.  Coco is adjusting well and learning the layout and location of key items in the new home thank to the hard work of Soyini.

Yamill & Bailey– Bailey has recovered from her spay surgery and is back to work.  The team is working and on basic commands along with some leave it’s, retrieving items, picking up items and the beginning stages of go get help. Bailey will be meeting with a potential recipient this month to see if they are a good match.

John & Simari are working on their service skills , including teaching Simari to hold an item in her mouth and carry.  This month we introduced the task of  “go get help” and have also introduced the “brace” command as well as retrieving dropped items.

Celia & Caroline continue to work on generalizing their medical tasks. We are working on the advanced stages of “block & cover” and the team is making good progress. We are also working on generalizing the touch command to apply this skill to additional tasks.

Wellness Tip

Valley Fever is a problem in dogs here in the AZ desert.  As the weather begins to warm and teams spend more time playing outdoors together, we remind handlers to be vigilant.  If it is a windy day, be cognizant that spores can blow around and cause infection.  Also be mindful of the dangers of digging in the dirt and your dog inhaling fungal spores.

Valley Fever is caused by a fungus known as Coccidiodes immitis.  During dry spells the fungus exists as spores, and can be dormant.  During rainy spells, the mold grows and can become airborne with the winds, or inhaled if the soil is disrupted by digging, gardening, construction, etc.

Symptoms of Valley Fever in dogs include but are not limited to:

  • cough
  • fever
  • decreased appetite
  • arthritis
  • lack of energy
  • weight loss

Remember that if any of these symptoms develop that there is no substitute for a complete veterinary exam.  If you find yourself asking “should I call the vet?” then it is time to make that call.

Thank You So Much!

Our sincere thanks to all those who have supported our programs and mission in the past month.

  • Valerie Schluter
  • Ron and Jackie Coslett
  • Armed Forces Support Group of Sun City Grand
  • Kari Troyer
  • Network for Good
  • Amazon.Smile

Your generosity and support is appreciated.

Photo Gallery

Many thanks to our hard working teams for sharing these photos from the past month.