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Equine Assisted Therapy

If you would like us to bill your medical insurance, please check with your plan to be sure Jennifer Walter, LISW-S, is in your network. If she is not or you do not want us to bill your insurance, we are taking self-pay and will provide you with a Super Bill you can submit to your insurance carrier.

Once you are registered, we will contact you to schedule your appointment. 

Who is seeking counseling

(mm/dd/yyyy)
You will be contacted to set up a date and time.
You will be contacted to set up a date and time.

Please let us know your therapy history.
Referrals are not required unless your insurance carrier requires it for services.

Please provide name, phone number, and email of person making referral.

Contact Information of Participant


*


PAYMENT OPTIONS

Please note HoofPrints is not a provider.
$

INSURANCE INFORMATION

Please contact your insurance plan to confirm Jennifer Walter, LISW-S is in your network. HoofPrints will NOT be listed as a provider. You will be responsible for any fees not covered. An Equine Fee may be assessed.


Often on the back of the card.



Please attach image of front and back of Insurance Card.