"Nature Therapy for Highly Sensitive Women" Registration Form
This program is focused on helping women who struggle with grief, 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 grief 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.
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.
THIS PROGRAM IS NOT APPROPRIATE FOR INDIVIDUALS WITH ANY OF THE FOLLOWING:
• 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.
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)
Individual sessions: $160
Group Sessions/Workshops: $20/hr
1.5 hr $30
3 hr $60
4 hr $80
6 hr $120
8 hr $160
NATURE THERAPY REGISTRATION FORM