Therapy Dog Visit Request Form

Organization Name

Type of Facility (e.g., school, hospital, nursing home, business):

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

First Name

Last Name

Title

Phone Number

Some description about this section

Preferred Dates

Preferred Times

Is this a one-time visit or recurring?

One-time

Weekly

Monthly

Other

If you selected other, please explain

Estimated Number of Participants:

Age Range of Participants (if applicable):

Reason for Visit / Desired Outcome: (e.g., stress relief, morale boost, therapeutic support)

Is there parking available for our team?

Yes

Noo

Is the visit indoors, outdoors, or both?

Indoors

Outdoors

Both

Any special instructions or requirements? (e.g., allergies, pet restrictions, accessibility info)

Some description about this section

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