Facility Visit Request

Facility Request

Use this form for long-term, regularly scheduled visits.

Please do not use this for a one time visit or presentation.

Facility or Business Name

Facility Phone

Facility Address

Facility City

Facility State

Facility Zip Code

Requestor's Name

Requestor's Phone

Requestor's Email

Preference of day/time of visits (Dogs are limited to a maximum of 2 hours)

Approximately How Many People Would the Dogs be Visiting?

Long answer

Do you envision individual visits with the dogs or would the dogs be visiting in a group setting?

If groups, how many people per group?

How many groups?

Please check the needs and/or challenges the people at this business or facility are facing. Check all that apply

Briefly describe how regular therapy dog visits will benefit the people they visit