Canine-assisted Skills and Wellness Referral Form
If you are a La Crosse County CCS or CLTS service facilitator and wish to refer a client to Crimson Hound for canine-assisted skills and wellness, please complete and submit this form. I will follow up with you to discuss scheduling services.
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Today's Date  *
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Service Facilitator Name *
Service Facilitator's Email *
Service Facilitator's Phone Number *
Funding Source & Type of Service Requested *
Required
Who is requesting this service for the consumer?
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An individual who is not on board is less likely to want to participate during sessions and is more likely to become frustrated and exhibit impatience with their pet.  This can have negative impacts on the human-animal  relationship.
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