HOPE AACR · HOPE AACR - Virtual Visit Request

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Virtual Visit Request

Our mission is one of HOPE, specifically to provide comfort and encouragement through animal-assisted support to individuals affected by crises and disasters. In response to the COVID-19 pandemic we are currently offering Virtual Visits in instances where person-to-person deployments are not deemed safe or prudent.

If your organization is interested in scheduling a virtual visit please fill out the following form and we'll see you (virtually) soon!

Preferred Date of Virtual Visit *

(mm/dd/yyyy)

Preferred Time(s) of Virtual Visit *

Service Requested *

Please list additional details, comments or questions here.

Contact Name *

First Name

Last Name

Preferred Phone *

Email *

Verify Email *

Organization (Optional)

Address (Optional)

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Please Select Your Region: *

Central Gulf Coast: NW, TX, OK, AR, LA

Northeast: ME, NH, VT, NY, PA, MA, RI, CT, NJ, DE, MD, VA, WV & Canada Provinces: Quebec, New Brunswick, Nova Scotia, PEI, Newfoundland & Labrador

Midwest: MN, WI, MI, IA, IL, IN, OH, MO & Canada Province: Ontario

Pacific Northwest: WA, OR, ID, AK & Canada Provinces: British Columbia, Alberta, & Yukon

Pacific Southwest: CA, NV, AZ, HI

Rocky Mountain: MT, ND, WY, SD, NE, UT, CO, KS & Canada Provinces: Saskatchewan, Manitoba, Northwest Territory & Nunavet

Southeast: KY, TN, NC, MS, AL, GA, SC, FL

Please select preferred technology *

Zoom

WebEx

FaceTime

Facebook Live

Not sure