Virtual Paws Request Form Our Pet Therapy Teams are ready to share the love! If you’re looking to bring a dose of ‘paws-itivtiy’ into the day of a resident, patient, student, staff or individual who could use some puppy love, schedule a video call with one of our Pet Therapy Teams! Our Virtual Paws Program aims to reach individuals who are alone or unable to receive physical visits. This unique face to face call encourages conversation and brings comfort and companionship. Hospitals, care facilities, universities, businesses, organizations and individuals requesting a Virtual Visit must have a designated person to facilitate the call using their own tablet, phone or computer and an app of their choice (i.e.: FaceTime, Zoom, WhatsApp, Skype). After completing the request form below and receiving confirmation that your call can be accommodated, you will receive information about the therapy dog who will be contacting you on the scheduled date and time of your Virtual Visit. Do you currently partner with Pets and Friends?*YesWe're on the waitlistNoInstitution Name* First Institution Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Name* First Last Position/Title*Primary Phone*Alternative PhoneEmail* Enter Email Confirm Email Preferred Date for Virtual Visit*Date must be at least one week from today. Date Format: MM slash DD slash YYYY Preferred Start Time for Virtual Visit* : HH MM AM PM Is your indicated date/time preference flexible?*YesNoPreferred Virtual Visit Duration*Our virtual visits can range from 15 to 60 minutes.15 minutes30 minutes45 minutes60 minutesPlease indicate which virtual meeting platform(s) you prefer.* FaceTime Zoom WhatsApp Skype Other Please estimate the number of participants that would be on the call.*How did you hear about Pets and Friends?Are you able to make a non-tax-refundable donation for this Virtual Visit?*Pets and Friends relies on the financial support of individuals, businesses and grantors to be able to offer our Pet Therapy program. Your support will help us continue to share the love through pet therapy visitations. If you indicate that you can donate, we will send you a donation link when we schedule your Virtual Visit. Thank you!$0$25 (suggested donation)$25+By clicking below, you agree to the following:*• Requests must be made at least one (1) week prior to your call. Some requests may require more notice. • The Pet Therapy Coordinator will review your request and generally respond within three (3) business days. • We cannot guarantee all requests will be approved as the ability to fulfill requests depends on the availability of our volunteers. • If necessary, please obtain any required written authorization from participants and/or their families or guardians before the call. • Recording of the virtual visit may be permitted if the pet therapy volunteer provides prior consent. • If you are no longer able to make the agreed upon time for the virtual visit, please kindly provide as much notice as possible. I agree to the policies listed below.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
