One Time Eastern Iowa Request - Easter Iowa Pet Therapy Referral Network

Please fill out the information below to request a one time visit in eastern Iowa outside of the Cedar Rapids or Iowa City metro areas. We will forward this request to teams that visit the area requested. 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.

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.

We currently have teams in Dubuque and Vinton

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.

Date of Event *

Please provide the preferred date for the event.

Date is Flexible *

Is this date flexible if teams are not available?

Start Time *

Please provide the time you prefer the visit to start.

End Time *

Please provide the time you prefer the visit to end.

Time is Flexible *

Is this time flexible if teams are not available?

Address of Event *

Address Line 1

Address Line 2

City

State

Zip Code

Please provide the address of the event.

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.

Description of Event *

Please provide a description of the event and location. Who will be attending, any special requirements, age range of visitors, etc.

Other Notes

Please provide any additional information you believe would help the teams.

Email *