CONSULTATION FORM | NeuroBalanced

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horse therapy, equine therapy, meditation, trauma, PTSD, anxiety, suicide, suicide prevention, non-medication, therapist, therapy, idaho, nampa, Idaho, counseling, alternative, brain optimization, neuralfeedback, neuralpathways, horses, horses, group workshops, womens, mens, workshops, corporate.

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CONSULTATION FORM

We offer group or family workshops. Please do not fill this form out if you are looking for individual sessions.

Contact Person Name

Phone Number

Email

What are you interested in? * Required

Group Workshop

Family Workshop

What services are you interested in (check all that apply): * Required

Neurofeedback

Equine Therapy

Any area of focus? Check all that apply. * Required

Anxiety

Depression

PTSD

Hopelessness

Panic attacks

Low self-esteem

Lack of or poor sleep

Inability to focus

Aggressive behavior

Anger/Rage

Suicidal thoughts

Self-harm

Recent trauma

Past trauma

Anything else you would like us to know?

How did you hear about NeuroBalanced?

NeuroBalanced does not accept insurance and is private pay only. Please check the box stating you are aware and accept.

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NeuroBalanced is part of the Back Forty Farms Ministry, a 508(c)(1)(a)

8899 S. Black Cat Road - Nampa, Idaho 83687

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