TOUCH – Monthly Visit Log

This form will be used in consideration for re-certification for ranking changes, as well as recording the active status of you and your dog.

  • Date Format: MM slash DD slash YYYY
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • Date of visitHours# PeopleT/P/HFacility
  • # People = ALL direct interaction between Handler and/or dog with patient, staff or visitors
  • This field is for validation purposes and should be left unchanged.