Programs Form Please fill out the form below and one of our staff will be in touch. PROFILE INFORMATION Client Name * First Name Last Name Preferred Name (if different) First Name Last Name Date of Birth * MM DD YYYY Height * Weight * Preferred Pronouns * She/Her/Hers He/Him/His They/Them/Theirs My pronouns aren't listed Prefer not to say Parent/Gaurdian Name * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Were you referred by a professional? If yes, please enter their name: Referring Professional Phone (if applicable) (###) ### #### Referring Professional Email (if applicable) QUESTIONNAIRE Tell us more about your interest in Equine-Assisted Services: * Do you have a diagnosis/disability you would be open to share with us at this time? * Select Program * Please choose the program you are interested in. Adaptive Riding - Mounted Horsemanship (Groundwork) Occupational Therapy Physical Therapy Mental Health Services Horse Powered Reading Women Veterans Program I'm not sure, I would like to learn more about the programs and services offered at High Horses. Please select all days you are available for sessions/lessons: Monday Tuesday Wednesday Thursday Friday Please select preferred time of day for your session/lesson: 9:30 AM - 12 PM 12 PM - 3 PM 3 PM - 5 PM Please provide us with any additional information or questions. Thank you for contacting High Horses. A staff member will respond to your inquiry as soon as possible. If you have any additional questions, please contact us at Hello@HighHorses.org or call (802) 763-3280.
