FORMS Return to Affinity Ranch Main Website

Prospective Client Registration Form

 

Thank you for your interest in our Ranch programs.

If you think you may have signed up in the past for Affinity Ranch (Praying Hands or Promise),
please contact our Office at 303-841-4043 and we can update your record instead of creating a duplicate.
Since we process our records based on date entered, you may slide farther down the list if you create a duplicate.

One form per client.

So we can customize your questions, please answer these questions before continuing:

Clients First Name
Clients Last Name
Programs You are Interested In? Check all that apply

Not sure what a service is, just hover over the service title.
Adaptive Horsemanship Horsemanship and riding lessons adapted to the client’s ability


Equine Assisted Therapy (aka Hippotherapy) - please select type(s) of therapyPhysical, Occupational, or Speech therapy while horse mounted or unmounted
    Occupational TherapyImprovement in Skills for daily activity/livin

    Physical TherapyImprovement in Physical function.

    Speech TherapyImprovement in communication, language and cognitive function.

Equine Assisted Learning An experiential learning technique that facilitates personal growth by teaching social, emotional, and life skills through horsemanship

Mental Health Psychotherapy with an equine partner where appropriate

    **Our Mental Health Providers are in network with Aetna, Cigna, Anthem. Blue Cross Blue Shield, United Healthcare, CO Access (medicaid), CCHA (medicaid), Denver Health Medicaid.  We also accept the following grant funds- second wind fund, Victims Compensation. **
Music & Movement TherapyThe use of music and movement to improve physical and emotional health.


Supported Employment Prevocational training, Job Development, and Job Coaching for adults with intellectual disabilities.


Veterans Programs - for Veterans Programs, please contact Operation Equine. You can find more info on their website at OperationEquine.org
Are you completing this form for yourself? Yes      No
Is the Client covered under a Community Based Provider? Yes (Developmental Pathways, Rocky Mountain Human Services) No
Do you have insurance that may cover your services(s) -
NOTE: Adaptive Riding Program is not eligible for Insurance		 Yes      No
Does the Client have a current ABA Provider? Yes      No