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Facility Request for Ongoing Visits

Welcome!

Dogs On Call is an all-volunteer organization, and all teams are registered Pet Partners.

Our visiting area is South Central Wisconsin.

Unfortunately, at this time we cannot visit the Milwaukee area

If you represent a facility and would like to request ongoing therapy animal visits, please complete the form below. If your request is for a one-time presentation or visit, please email: info@dogsoncall.org

How it works:

Eligible requests are included in a monthly emailing to members. If a member is potentially interested in visiting your facility, you will be contacted directly by that member. Your request will remain on our list to be continuously available to our members; please understand that we will do our best to fulfill your request, but we receive more requests than we can possibly fill.

If your facility is not eligible for listing in our monthly email due to special requirements, the appropriate coordinator will contact you.

Thank you for reaching out to Dogs On Call.

Facility Request for Ongoing Visits

Step 1 of 3

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Facility & Contact Information
Facility Name*
Address*
Street Address Address Line 2 City State ZIP Code
Name of Facility Director*
First Last
Contact Person (Your Name)*
First Last
Contact Title*
Your Title
Contact Phone*
Your Phone
Contact Email*
Your email
What are your preferred days and times for visits?*
Type of Facility
Please check the category or categories that most accurately describe your facility:*
- Assisted Living
- Skilled Nursing
- Memory Care
- Hospital
- Psychiatric Facility
- Hospice
- Library
- Campus, Dorm, or College
- School (non-college)
- Other (please describe)
Other (please describe)*

Facility Information
Please tell us a little about your facility.
Total number of residents.*
How Many?
What kind of group would receive Dogs On Call visits?*
- Small group (1-5)
- Medium group (5-15)
- Large group (15+)
- One-on-one, room-to-room visits
How many one-on-one, room-to-room visits?*
Please describe your facility in your own words*
Staffed 24/7?*
- Yes
- No
Will staff either be present in room with therapy animal team or readily available if needed?*
- Yes
- No
Please check the box that best describes the dynamics of your facility.*
- Quiet
  low activity, few distractions, routinely predictable interactions
- Average
  moderate activity, moderate distractions, some unpredictable interactions
- Active
  high activity, many distractions, routinely unpredictable interactions

Hidden
Facility Information (continued)
Please describe your program goals for therapy animals in your facility*
Do you have a written visiting animals policy?*
- Yes
- No
If yes, please upload here*
Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 32 MB, Max. files: 2.
Is there a formal volunteer application?*
- Yes
- No
Does your facility require a background check for volunteers?*
- Yes
- No
Does your facility require a volunteer orientation or training?*
- Yes
- No
If yes, please briefly describe orientation or training*
Might there be other animals in the facility, such as residents’ pets, permanent facility animals, or visiting family pets?*
- Yes
- No
If yes, please describe*
Please describe any specific animal requests and requirements (species, size).*
Dogs On Call has dogs, but we have cats and rabbits, too, that are registered therapy animals!
Do you have other therapy animal groups or teams currently visiting?*
- Yes
- No
If yes, please describe.*
Are there other requirements or special notes of which we should be aware?*
- Yes
- No
If yes, please describe.
Acknowledgements
Please acknowledge the following DOC requirement:*
- Facility will discuss DOC requirements and facility requirements with interested teams prior to visits.
Please acknowledge the following DOC requirement:*
- Facility must provide a sign-in/sign-out log for teams.
Please acknowledge the following DOC requirement:*
- Facility must inform teams of preferred sanitation protocols.
Please acknowledge the following DOC requirement:*
- Facility must inform teams if any patients are in isolation/quarantine, as teams cannot visit these patients.
Please acknowledge the following DOC requirement:*
- Facility must inform teams of any infectious outbreak, so teams can temporarily suspend visits.
By submitting this request, I certify that I am authorized to request visits on behalf of the named facility. I further give permission for Dogs On Call, Inc. to provide all submitted information to DOC members, and for any interested members to contact me directly for more information.
Email
This field is for validation purposes and should be left unchanged.

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