If you would like to request a Therapy Dog for a child, youth or individual in need, please fill out the form below and we will contact you shortly.

Or you can call Marina Mlynczyk, FETCH/ATD Court Therapy Dog Coordinator, at (541) 513-3995.

  • Requesting Party Information

  • Example: DHS Caseworker, CASA, Attorney, etc.
  • Child Information

  • Enter the first name of the child or youth who will benefit from the services of a court therapy dog
  • Select the age of the child/youth
  • Enter the gender of the child/youth
  • Scheduling Information

  • MM slash DD slash YYYY
    Select the date services are needed
  • :
    Enter the anticipated time services are needed
  • Please enter how long you think services will be needed for (Example: 30 minutes, 2 hours, until 1 PM, etc.)
  • Enter the case number (if available)
  • Please enter a brief explanation about why you are requesting the services of a court therapy dog.