TRAUMA CARE & RECOVERY INQUIRY
COMPLETE THE FORM BELOW AND OUR TEAM WILL ASSIST YOU ON YOUR WELLNESS JOURNEY
TODAY'S DATE
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Month
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Day
Year
Date
EMAIL
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CLIENT'S NAME
First Name
Last Name
CLIENT'S DATE OF BIRTH
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Month
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Day
Year
Date
PHONE NUMBER
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian Name is under 18 years old
First Name
Last Name
PLEASE CHECK THE AREAS OF INTEREST. A TEAM MEMBER WILL REACH OUT BASED ON YOUR CHOICES BELOW.
MENTAL HEALTH COUNSELING: EQUINE ASSISTED AND TRADITIONAL SESSIONS
EQUINE ASSISTED COACHING OR LIFE COACHING
A.R.T. ACCELERATED RESOLUTION THERAPY
SOMATIC RELEASE COACHING
LIFE COACHING
CHRISTIAN INTEGRATED COUNSELING/COACHING
NATURE BASED THERAPY
EMDR: TRADITIONAL OR EQUINE ASSISTED
TERRAIN: AO SCAN SERVICES FOR NUTRITION/ALLERGIES AND BODY HEALTH
BELIEF CODE RELEASE
CUSTOM BALANCE REMEDIES AND NUTRITION
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