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Request for Consultation Services
Maddie's® Shelter Medicine Program at Cornell University
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Email
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Your email
Today's date
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Please answer all questions on this questionnaire.
Name of person completing form
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Your answer
Position within organization
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Your answer
INQUIRING ORGANIZATION
Name of Agency
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Your answer
Physical Address
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Your answer
City
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Your answer
State
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Your answer
Zip code
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Your answer
County in which brick & mortar structure is located.
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Your answer
How many facilities does your organization operate?
Your answer
Please describe your reasons for requesting a consultation.
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Your answer
Please describe your goals for this consultation.
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Your answer
Has this agency previously worked with a consultant, assessment, or advisory team? If so, please describe.
Your answer
What would be the preferred time frame for this consultation?
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Within the next 3 to 6 months
Within the next year
Sometime next year
we are having an infectious disease emergency and need help quickly
If requesting a targeted consultation, which topic(s) would this consultation address?
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Disease outbreak response
Population mamagement
Intake processing
Housing and Husbandry
Cleaning and disinfection
Facility design renovation
Behavioral enrichment
Foster program
Staff training
Actually, we need a comprehensive full shelter consultation.
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