Questionnaire for Facilities Wishing Visits from Registered Pet Partner Teams
Please complete this questionnaire as completely as possible. The information will be placed in a list that will be given to all new Pet Partners as they complete their Team Evaluation. In addition, if your facility is not currently registered with us, an email will be sent to all current Pet Partners making them aware of your request. If a team is interested in working with you and able to meet your schedule, you will be contacted directly by the the team. Unfortunately, ElderPet cannot guarantee that a team will choose any specific facility.
Facility Name: *
Facility Address (Street, City, State, Zip): *
Contact Person and Title: *
Contact Phone Number: *
Contact Email: *
Facility Website: *
Type of Facility: Please choose any that apply *
More About Your Facility
To enable our teams to determine if your facility is the appropriate environment for their skill level and their time constraints, please continue to complete the following information.
Number of Clients/Beds /Residents (if applicable)
Does Your Facility receive pet visits now? *
Do you request/require registered or screened teams? *
If Yes above, please indicate the therapy animal registering agencies or screening you require. Choose any that may apply.
What species of visiting pets would your facility welcome? *
Please list any specific day or time considerations your facility requires for visits. (e.g. M-F only, no evenings) *
Does your facility regularly have pets on the premises other than visiting teams? *
If you have pets on the premises, please check any that apply.
Information Pertaining to the Human Volunteer
Please answer the following questions as far as they would pertain to the handler bringing the pet.
Does your facility require a volunteer orientation? *
If yes, please describe:
Does your facility require any of the following for human volunteers? *
Other comments or information you wish to share:
Facility Consultations
If your facility would like to set up a simple pet visiting program or if you wish to have your current program assessed, ElderPet board members would be happy to arrange a consultation at no charge.

In addition, if your facility would like explore establishing a robust, professionally-directed Animal Assisted Therapy program, one of our advisory board members, an occupational therapist with human-animal interventions experience, will be happy to consult with your professional staff about what is needed as far as environment, population and goals for the program.

If your facility is interested in a consultation, please email and put "Facility Consultation" in the subject line and explain what you are looking for.

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