Regular Ongoing Cedar Rapids Area Request - Easter Iowa Pet Therapy Referral Network

Please fill out the information below to request regular ongoing visits in the Cedar Rapids area. We will forward this request to teams that visit the Cedar Rapids area. The teams are responsible for contacting you individually. We cannot guarantee a match for this request as teams manage their own schedules and can be quite busy. The intervals for the visits must be arranged with the responding team.

Our teams often have day time employment so requests during normal business hours may be more difficult to fulfill.

You are responsible for requesting certification information, insurance coverage or other documentation you require from the teams.

Organization Name *

Please provide the name of the organization requesting the visit.

Contact Name *

Please provide the name of the individual organizing the event.

Contact Email *

Please provide the best email to use when making arrangements

Contact Phone *

Please provide the best phone number to contact in case of questions or emergencies.

Preferred Frequency of Visits *

Day of Week is Flexible *

Is the day of week flexible to accomodate the schedule of the team?

Earliest Start Time *

Please provide the earliest time you prefer the visit to start.

Latest Time to End *

Please provide the latest time you prefer the visit to end.

Time is Flexible *

Is this time flexible to accomodate team schedules?

Address of Visits *

Address Line 1

Address Line 2

City

State

Zip Code

Please provide the address of where the visits will take place

Parking is Provided *

Will parking be provided?

Additional Instructions for Parking *

Please provide enough information for the teams to know where they should park and if there is a cost.

Visit Information *

Please provide a description of the type of facility and visit expectations. Who will be attending, any special requirements, age range of visitors, etc. Include any additional notes you believe would be helpful to the team.

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