Interested in learning more about Nature-Based and Animal-Assisted Therapy?
Fill out form below
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Are you or your child currently a client?
Yes
No
Was previously
How did you hear about this program
Online Search/Ad
Print Ad
Social Media
Children's Home Counselor
Doctor/Clinician
Friend/Family
Other
Message:
*
I agree to receive communications by text message from the Children’s Home Counseling Services about my inquiry. You may opt-out by replying STOP or ask for more information by replying HELP. Message frequency varies. Message and data rates may apply.
You may review our
Privacy Policy
to learn how your data is used.
Submit
Should be Empty: