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Home
About Us
- Meet the Team
- King’s Ranch Ministries
Parents
Support Systems
Certifications
- Parent Coach Certification
Log In

Home
About Us
- Meet the Team
- King's Ranch Ministries
Parents
Support Systems
Certifications
- Parent Coach Certification
Log In

Therapist Referrals

Therapist Referrals

Name

First

Last

Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Email

Therapy Background

Type of Therapy (Physical Therapist, Occupational Therapist, Speech Therapist, etc)

What is your primary clientele/specialty (ex. Couples, children from trauma)(Required)

Please list the therapy techniques you use during therapy (ex. brain spotting, EMDR)(Required)

Have you had or currently have clients complete an Unplowed Ground training?(Required)

Yes

No

Are you familiar with Unplowed Ground therapeutic parenting? If no, what parenting program do you use/recommend?(Required)

Yes

No

What parenting program do you use or recommend?

Do you provide telehealth therapy?(Required)

Yes

No

Do you take insurance, if so what type?(Required)

Yes

No

Types of Insurance Accepted

Do you provide faith-based therapy? If so, in what capacity?(Required)

Yes

No

Faith-based therapy services provided:

For over 15 years, we have worked with hundreds of children with suffering from the effects of childhood trauma. At Unplowed Ground, we will empower you with strategies to move your child toward a more secure attachment.

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