Referral Form 
Thank you for taking the first step towards referring your child to Play & Creative Arts Therapy.
Once you've completed and submitted this form, we'll be in touch.
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Email *
I confirm that I have read and agree to Innerventure's Terms and Conditions. *
By submitting this Referral Form, you accept these Terms-, even if you do not sign them.
Required
I am aware that if I miss an appointment, or cancel with less than 24 hours' notice, charges will apply. *
Required
I consent to Innerventure collecting and managing my, my child's, and my family's personal data in line with Innerventure's Privacy Policy and the current Data Protection Regulations (GDPR). *
Required
I request to engage with Innerventure's proposed: *
* If applicable, travel costs will be additionally charged.
Payment is required before works are carried out. 
If you are unsure how you wish to proceed, please contact us by booking a Discovery Call through our website (www.innerventure.co.uk).
Today's date *
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Your name: *
Telephone number: *
Who is the Child you are referring for Play Therapy Services?  *
Please provide the Child's Full Name:
Child's Date of Birth *
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Child's Gender : *
Child's preferred pronoun: *
Billing Address: *
Residential address: *
Your relationship with the child: *
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