Veterans Programs V.E.T.S (Veterans Equine Therapeutic Services)

General Information

Participant's Name *

First

Last

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Please indicate any changes to the participant's health or life circumstance

Participant's weight (lbs)

New medical diagnosis

If yes, please comment

Recent surgeries

If yes, please comment

New injuries

If yes, please comment

Changes to living / social circumstance

If yes, please comment

For which program are you applying? *

On a scale of 1 to 5, how would you rate the overall experience of the Equine Assisted program? *

1 (Very Poor)
2 (Poor)
3 (Average)
4 (Good)
5 (Excellent)

To what extent do you agree with the following statements regarding the program's impact on social-emotional outcomes for the participant? (1 - Strongly Disagree, 5 - Strongly Agree)

The participant has shown increased self-awareness. *

The participant has improved in managing emotions. *

The participant has better social interactions with peers. *

The participant has enhanced empathy and understanding of others. *

Please provide specific examples of any changes you have observed in the participant's social-emotional skills:

[Open-ended response] Optional

Skills Learned

Which of the following skills do you feel the participant has developed during the program? (Select all that apply) *

Communication skills
Problem-solving skills
Leadership skills
Teamwork and cooperation
Responsibility and accountability
Other

Please Specify

On a scale of 1 to 5, how effective was the program in teaching these skills? *

1 (Not Effective)
2 (Slightly Effective)
3 (Moderately Effective)
4 (Very Effective)
5 (Extremely Effective)

Goals and Accomplishments

What were the initial goals for the participant when starting the program? *

[Open-ended response]

To what extent do you feel these goals were achieved? (1 - Not at all, 5 - Completely) *

Please describe any specific accomplishments or milestones the participant reached during the program:

[Open-ended response] optional

Would you recommend the Equine Assisted program to other parents and caregivers? *

Yes
No
Maybe

Please Explain

A current physical is required. Please upload the participant’s most recent physical, sports physical, or well-child check completed within the past 12 months (.pdf)

Click or drag a file to this area to upload.

To register for your next session please complete the following

General Information

Please indicate any changes to the participant's health or life circumstance

To what extent do you agree with the following statements regarding the program's impact on social-emotional outcomes for the participant? (1 - Strongly Disagree, 5 - Strongly Agree)

Skills Learned

Goals and Accomplishments

Contact Information

Hours