CLIENT FORMS | Rise Canyon Ranch

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Client forms

Download and complete the forms for your age group. Please bring them with you to your first session.

For clients 18+

Intake Form (Adult)
Informed Consent
Release of Liability (Rise Canyon Ranch)
Release of Liability (Anaheim Hills Saddle Club)
Notice of Privacy Practices (HIPPA)
Acknowledgement of Privacy Practices
Authorization to Exchange PHI
Assignment of Benefits
COVID-19 Risk Waiver

For clients under 18

Intake Form (Child)
Informed Consent
Release of Liability (Rise Canyon Ranch)
Release of Liability (Anaheim Hills Saddle Club)
Notice of Privacy Practices (HIPPA)
Acknowledgement of Privacy Practices
Authorization to Exchange PHI
Assignment of Benefits
COVID-19 Risk Waiver

Rise Canyon Ranch is a California non-profit 501(c)(3) that provides equine-assisted psychotherapy (EAP), which utilizes the unique emotional connections of horses to engage children, teens and adults in healing, self-discovery and enrichment.

Donations are fully tax-deductible.
Federal tax ID #82-4700130.

PHONE

(714) 477–1630

EMAIL

info@risecanyonranch.org

MAILING ADDRESS
3419 E. Chapman Ave.

Suite 346 Orange, CA 92869

Please contact us for our facility location.

COPYRIGHT © 2020 · RISE CANYON RANCH