Therapeutic Services Forms
 

To sign up for Therapeutic Services at Furnace Brook Farm, please complete and submit the following forms. You may also print and complete a hard copy of your forms when you come for your first visit to Furnace Brook Farm. Things to note:

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  • There are 4 forms to complete in order to register. They are listed in Step 1 - Step 4 below.

  • Step 1 - Step 3 forms may be completed and submitted online. Click the red "online" buttons below.

  • The Step 4 form -  "Therapeutic Riding Physician Paperwork must be printed and brought to the participant's physician to be completed.

  • Your online forms (once completed) may be printed out for your records. Look for the printer icon at the end of each form.

  • Printed forms may be mailed to: Furnace Brook Farm, 253 Sandy Hill Drive, Marshfield, MA 02050 Attn: Erin Van Steenburgh.

  • Therapeutic Riding Physician Paperwork (Step 4) should be mailed to Furnace Brook Farm.

STEP 1: Therapeutic Services General Information

Choose ONE option:
Click to complete & submit online
Click to print form

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STEP 2: Medical Treatment Authorization

Choose ONE option:
Click to complete & submit online
Click to print form

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STEP 3: Photo & Publicity Release and
Liability Release

Choose ONE option:
Click to complete & submit online
Click to print form

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STEP 4: Therapeutic Riding Physician Paperwork

Choose ONE option:
Click to print form

NOTE:
Step 4 must be printed and completed by participant's physician. This cannot be completed online.

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