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Referral Form

Please complete this form prior to booking your free consultation, remembering to answer briefly, as there will be an opportunity to go into greater detail during the free consultation before making a therapeutic agreement.  In order to submit a referral, please read my privacy policy, including how I handle and store you data, before submitting your referral.

Pre-therapy referral form
Are you referring yourself for art therapy?
Select all that apply
I have read and accept the privacy policy:

 

Elle Gilbertson is committed to inclusivity and welcomes people of all ethnicities, LGBTQIA+, people with disabilities, and people of all ages. 

The information on this website is for informational purposes and is not intended to replace medical or psychological assessment and treatment. 

Please note that I do not offer a crisis or emergency service. In such situations, if you are living in the UK I would recommend that you contact your GP during clinic hours, attend your local Accident & Emergency department, or dial 999 in an emergency. If you are from outside the UK please have a look on the befrienders website for crisis support in your country. www.samaritans.org. and www.befrienders.org

All images and content on this site are ©Elle Gilbertson 2020 -21 and may not be copied, published or used without permission.