Facility Form | Pets and Friends

Today's Date*

Facility Name*

Facility Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website

Facility Contact*

First Last

Position/Title*

Primary Phone*

Alternative Phone

Email*

Enter Email Confirm Email

Fax

Type of Facility*

How frequently would you prefer pet therapy visits?*

Time(s) most convenient for pet therapy visits*

Would you prefer weekend or weekday visits?*

What areas will the pet be visiting?*

Individual room
Common areas where the residents/patients meet during the visit
Specific unit or floor only
Other

Number of Pet Therapy Teams requested:*

COVID-19 Protocol for Volunteers:*

Description of Pet Therapy Opportunity:*

Describe the onboarding steps for a pet therapy team at your facility*

Once a pet therapy team has been referred to you, what steps will they need to take before they can begin volunteering? For example, an application, interview, references, orientation, site tour, buddy visit or shadow shift, etc.. If there are no steps beyond those of Pets and Friends, you may also note that.

How did you hear about Pets and Friends?

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Email

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