BIT OF HOPE RANCH INQUIRY FORM

Today's Date

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Client Name *

First Name

Last Name

Client Birthdate

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GUARDIAN NAME

IF CLIENT IS UNDER 18 YEARS OLD

First Name

Last Name

Phone

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PLEASE CHECK THE AREAS WHERE YOU ARE SEEKING ASSISTANCE

Mental Health Counseling: Traditional or Equine Assisted Therapy

Equine Assisted Coaching or Life Coaching

Discovery Sessions: MACE or Emotion Code

Social: Family, Relationships Counseling/Coaching

Physical: Therapeutic Riding/ Special Needs

Physical: Recreational Riding/ Saddle Club/ Lessons

Physical: Primary Care, Lab/RX or Body Work Referrals

Terrain: Naturopathic or Functional Doctor Referrals

Spiritual Guidance

Financial Coaching and Planning

Life Purpose: Life/Vocational Coaching