6 Month Follow-up Report



SUPPORT DOGS, INC.

11645 LILBURN PARK ROAD • ST. LOUIS, MISSOURI 63146 314.997.2325 • FAX 314.997.7202 • www.supportdogs.org

TOUCH HandlerSix Month Visitation Log

Please complete the following information for each consecutive six month period you are making visits. At the end of each six month period, return this form to Support Dogs, Inc.

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

This form can be mailed, faxed or emailed to cblanke@supportdogs.org

  • Handler Name:
  • Dog's Name:
  • Address:
  • City/State/Zip:
  • Phone:
  • eMail:
  • Date Of Original Certification:
  • CurrentTeam Ranking:

  • Facility Visited: 
  • Date Of Visit: 
  • Dates, Days and Times Of Visits: 
  • TOUCH Visitation or Acting Coordinator: 

  • Facility Visited: 
  • Date Of Visit: 
  • Dates, Days and Times Of Visits: 
  • TOUCH Visitation or Acting Coordinator: 

  • Facility Visited: 
  • Date Of Visit: 
  • Dates, Days and Times Of Visits: 
  • TOUCH Visitation or Acting Coordinator: 

  • Facility Visited: 
  • Date Of Visit: 
  • Dates, Days and Times Of Visits: 
  • TOUCH Visitation or Acting Coordinator: 

  • Facility Visited: 
  • Date Of Visit: 
  • Dates, Days and Times Of Visits: 
  • TOUCH Visitation or Acting Coordinator: 

  • Facility Visited: 
  • Date Of Visit: 
  • Dates, Days and Times Of Visits: 
  • TOUCH Visitation or Acting Coordinator: 

  • Facility Visited: 
  • Date Of Visit: 
  • Dates, Days and Times Of Visits: 
  • TOUCH Visitation or Acting Coordinator: 


TOUCH Handler Signature:

Date: