Wait list for individual session
Please fill in this form to join our waiting list for free Art Therapy Individual session. Filling this
Your information is confidential and will not be shared with anyone else.
First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Email *
Your answer
Phone *
Your answer
What are you dealing with and would like support for? *
Do you identify with the LGBTQ2S community? (this will help us identify funding opportunities) *
Are you a visible minority? (this will help us identify funding opportunities) *
What is your current annual income? *
Are you currently on any financial assistance from the government *
If yes, what programme are you on?
I declare that all the information above is true. *
If you are granted financial support from our 'Therapy Support Fund', we do have a few requests:
- We do ask that you write a thank you note to our donors. This will help them understand and feel the impact they have made in someone else's life.

- We have a before and after survey for you to fill in. Your identity will be protect. The survey results will help us continuously improve our programmes and services. This will also help others with similar experience as yours to understand how art therapy can potentially support their mental health needs.

Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service