Who is this referral for? *

Me

Someone Else

Name *

Add the name of the person filling out this form

First Name

Last Name

D.O.B. *

Add Date of Birth for person being referred

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DD

YYYY

Phone *

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What is your preferred contact method?

Email

Phone

Open to All

What is your chosen rate?

We offer a no questions asked approach. It costs approximately £50 for CATS to run therapy sessions, please choose a rate that aligns with your circumstances so we can continue to provide the choice and care we aim to.

£40 - Reduced Rate

£50 - Students and Underemployed

£60 - Standard Rate

What services are you interested in?

Art Psychotherapy

Music Therapy

Dramatherapy

Open to All

Have you read and understood our Privacy and Confidentiality Information Pack? *

If you need support with this process please get in touch through our referrals email.

Yes

No