Animal Friends Therapets Questionnaire for Dogs
Thank you for your interest in Animal Friends' Therapets! We appreciate you taking the time to fill out this short questionnaire so we can learn more about you and your dog.

Someone will be in touch with you shortly to discuss next steps.

Name: *
Your answer
Phone Number: *
Your answer
Please include town and zipcode. This is to help match you with facilities in your area that are looking for animal therapy.
Your answer
Email: *
Your answer
What is your dog's name? *
Please provide pronunciation if it is a unique spelling.
Your answer
What breed (or mix) of dog is he/she? *
Your answer
How old is your dog? *
We require an animal to be at least one year old before joining our program. Please call if you have questions or would like to discuss options for younger animals. You are welcome to fill out the form for an animal under one year of age - we'll keep in touch!
Your answer
How long have you had your dog? *
We require you to have owned or cared for your potential therapy animal for at least six months before starting our program. We want to make sure you have time to bond and establish a good foundation for teamwork.
Your answer
Is your dog spayed/neutered? *
We require all animals in our program to be spayed or neutered. If your animal cannot be safely altered for medical reasons, please contact us to discuss your options.
Is your dog up-to-date on his/her rabies and distemper vaccinations? Titers are not accepted. *
Please select "other" if your pet cannot be vaccinated safely, and please explain in the space provided.
Why do you feel your dog is well-suited for therapy work? *
Your answer
Does your dog currently have any behavior or obedience certifications? *
Examples: TDI, Pet Partners, CGC, Paw Pals, BIB. Please tell us which in the "other" text area.
Are you planning on being the only handler during therapeutic visits? *
We certify teams, not individual animals or humans. If more than one person wants to be a handler, they will need to attend the evaluation and pass the Certification Test with the dog as well.
Are you and any other potential handlers over the age of 18? *
Our program requires handlers to be over 18 years old. Please contact us to discuss options for younger volunteers.
Please describe how your dog behaves around other dogs and animals. *
Your answer
Has your dog ever bitten/attacked another animal or person? *
If you answered 'yes' to the question above please describe in as much detail as possible the circumstances surrounding the biting incident(s):
Your answer
What is the best time for you to come in for an evaluation? *
How did you find out about the Animal Friends Therapets program?
Please check all that apply.
Are you a UPMC Hospital Employee? *
The Beckwith Institute has partnered with Animal Friends to offset the cost of training for UPMC Hospital Employees. If you are approved at the evaluation and at testing, you are asked to make at least 6 visits to your hospital of employment in the 2 months following certification as agreed upon in the partnership.
If yes, what UPMC Hospital do you currently work for?
Where would you like to attend the Therapets Prep Class? *
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