Horticultural Therapy Services

Application for Services

Acceptance of your application will be subject to availability of schedule openings. Please call (847) 835-8247 or visit if you have questions.

Items market with a * are required. Form will not send unless these fields are filled in.

*Name of Agency:    
*Applicant name: Administrator name:
*Applicant email: Administrator
Street address: Fax:
Zip/Postal code:

What audience does your agency predominantly serve?

(Please describe your audience, including current functional abilities, to help us better tailor your program.)

What are your goals for the program?

What are your goals for the individuals you serve?

Do you have an existing garden area? If yes, please describe.

How did you learn about our horticultural therapy program?


Private Krankenversicherung