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Ecotherapy Intake Request

If you are interested in Equine-Facilitated Ecotherapy please complete this form and  I will contact you to arrange an Intake Session.

Are you interested in: *
(Small Group Sessions will run when there are 4 people available for the same weekly time block.)
Name *
Home Phone
Home Phone
Cell Phone
Cell Phone
Preferred Phone #
Please check all days and times you are available: am= start time 10:00 am; pm= start time 1:00 pm; hs = start time 5:00 pm (winter)
Are there any particular dates that you would not be available (from the choices made above):