"Nature Therapy for Highly Sensitive Women" Registration Form

This program is focused on helping  women who struggle with deep sadness, anxiety or despair as a result of being especially sensitive to the suffering of animals and devastation of the environment (eco-anxiety/eco-grief). 

PLEASE READ the following prior to completing the intake form below: 

  • This is a Nature-based program to help highly sensitive women who struggle with deep sadness or despair in response to the suffering of animals and our planet, create hope in their lives by embracing their grief and finding creative and personally meaningful ways to make a difference related to what most breaks their heart. Minimum age for participation is 18 years old.

Please Note:  

  • This is an Experiential Therapy Program (versus talk therapy)

  • It can be helpful in conjunction with, but does not replace, talk therapy.

  • It is best suited for those who have already done some core work (with or without a therapist) related to family of origin and trauma-related issues, and are ready and motivated to take action to move forward in their lives.

  • Medication/prescription management services are not provided

  • All participants must be followed by a family doctor/GP and, if indicated, a psychiatrist or other mental health professional.

  • The sessions are primarily outdoors and involve time in Nature and with Horses, Donkeys, and other animals. The reflective/creative arts/integration components of the session will be in a heated/sheltered area or indoors if cold or raining.

  • Sessions run rain, snow or shine except for severe weather that affects road conditions or safety outdoors.


•  Substance abuse/dependency (active or within last 3 years)
•  Hospital admission for psychiatric disorder within past 12 months
•  Mental Health issues that significantly impair daily functioning (e.g. not able to work)
•  Severe Anxiety, Depression or other Mental Illness
•  Suicidal thoughts or Psychosis
•  Borderline Personality Disorder

As I am not able to provide the level of support and care required

Moderate Anxiety or Depression must be under care of GP or Mental Health Professional (and must be in at least partial remission)

Note: I am offering all therapy services as a physician under my medical license. The information gathered on this form is necessary to provide optimal services to you; meet the medical charting requirements of the Alberta College of Physicians & Surgeons; and to verify that the eligibility criteria are met for Alberta Health Care Insurance Plan (AHCIP) coverage. All information provided is confidential as per the Health Information Act (HIA) of Alberta. Thank you.

**Cancellation Policy
3 business days notice is required for cancelling a therapy session.

*N.B.: I can not bill Alberta Health Care if we do not have an in-person session (sessions can not occur via phone, Skype, etc.)

Excluding emergencies/extenuating circumstances, cancellations made with < 3 business days notice will be subject to the following fees. Fees, which cover only a portion of the Alberta Health Care billing rate, must be paid in full before your next session. 

No-Shows for scheduled sessions may result in discontinuation of further sessions. (No-Shows for initial intake session will not be rescheduled)

**Cancellation Fees**
Individual sessions: $160
Group Sessions/Workshops: $20/hr
1.5 hr    $30
3 hr       $60
4 hr       $80
6 hr     $120
8 hr     $160



Note: A username and link will be emailed to you after I receive this form, so you can complete a few more questions without providing identifying information.

I agree to the following: *
(both boxes must be checked)
Name *
Birthday *
Address *
Cell Phone *
Cell Phone
Home Phone
Home Phone
I am interested in *
Availability for Intake/Individual/Small Group Ecotherapy Sessions
Please check all time slots that you could be available. Weekend sessions are in great demand, so please indicate if a weekday is possible. Sessions last ~ 2.5 hrs and ongoing sessions are typically scheduled for the same slot each week with reassessment every 4 weeks
If from a doctor or other healthcare provider please include name

Thank you!