Therapy Team Visit Request Form

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This form is for organizations in the Charlotte Metro area to use to request an IPP Therapy Dog Team. We will use this information to communicate the need to our teams. Please feel free to contact us at invisiblepawprints2016@gmail.com with any questions.

Email *

Name of Organization *

Contact Name *

Contact Phone Number *

Organization Location (address and any other details handlers would need to find the correct location) *

What type of therapy support is needed? *

Childhood Learning/Reading Assistance

Residential care facility visit (multiple patients in a residential-style care facility)

Hospital-Adult

Hospital-Pediatrics

Hospice Care

Mental Health/Substance Abuse

Courtroom Emotional Support for Minors

College Study Stress Relief

Other:

Is this request for specific event date(s) or ongoing need? *

Specific Date(s)

Ongoing Need

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