Above & Beyond Program Intake Form

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Thank you for your interest in Above & Beyond, our program for first responders, public safety personnel and/or military.

We will be in touch to set up a follow-up call when a program becomes available.

Participants are expected to attend and complete the full program.

Please complete the form below to apply. Your honest answers will help us to provide you and the group with the best care possible.

Your information will only be shared with Horse Sense North mental health team members who are obligated to maintain client confidentiality.

Email *

First and Last name: *

Pronouns you would like us to use for you:

She/her, he/him, they/them, other, or leave blank if you'd prefer not to say

Date of Birth: *

Best phone number to reach you: *

May we leave a message for you at this number that offers information about an upcoming Above & Beyond program?

(When programs become available, we first try contacting you by email.)

YES

Required

Current address: *

How did you hear about this program? *

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