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Project Referral Form - FREE sessions

T4H Virtual / Telephone Complementary Health Support

FREE SESSIONS over the telephone or zoom

Complete the referral form below and submit. Someone will contact you to talk about your situation and arrange your first session, usually within 7 working days.

NB. Please note that a call may come from a private number.

Project Referral form:

Which age bracket are you?

Under 18

18 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65+

80+

Which ethnicity do you identify with?

Asian or Asian British

Black, African, Caribbean, Black British

Mixed/Multiple Ethnic backgrounds

White

Any Other

What gender do you identify as?

Female

Male

Transgender

Non-Binary

Other

Do you consider yourself to have a disability or long term condition?

Yes

No

Have you had a positive Covid-19 test at any point?

Yes

No

Which would you prefer if you start having sessions?

Telephone

Video / Zoom

Face to face (if possible)

Therapy 4 Healing take your privacy seriously. Read more about how Therapy 4 Healing collects, uses, protects and transfers your personal data.

Thanks for submitting! Someone will be in touch.

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Therapy 4 Healing Registered in England No 7103929

T4H Head Office, 120 Stanstead Road, Forest Hill, London. SE23 1BX

Tel: 020 8617 8820