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Equine Assisted Psychotherapy Client Information Form
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Client First Name
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Client Last Name
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Your answer
Nickname or Aliases
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Age
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Your answer
Gender
*
Your answer
Preferred Pronouns
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Your answer
Name of parent/guardian/caregiver
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Home Address
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Best Phone Number
*
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Calls will be discreet, but please indicate any restrictions.
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Best Email
*
Your answer
What type of therapy are you interested in?
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Individual
Family
Trauma Recovery Group -- ages 18 and up -- 10 Week Program
Teen Group -- ages 13-17 -- 12 Week Program
Kids Group -- ages 8-12
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