New user registration

Self referral registration

Please use this form if you are an individual / family self-referral, looking to use our services. 

Important

This form is for self-referrers only. If you are an oranisation or GP interested in becoming one of our referrers, please contact us.

E.g. GP, EWMHS, School Nurse, Health Visitors.
If you are referring in more than one member of your family, please confirm DOB next to each name in the next box.
If different to parent / guardian
Please include age ranges of adults & children
Please include parents / guardian, children aged 4+
I agree to be accountable for each session, to be educated on the wellbeing techniques that will be coached / mentored via N.O.W's Team.

I understand that I will be responsible for making the sessions (or for ensuring a minor taking the child course) on time and if for any circumstances the session cannot be adhered to the time / date booked, I have 48hrs before the date to notify N.O.W's head office by email or phone in order to reschedule the session.

If any session is missed and N.O.W's is NOT notified, the week will be deducted from the overall 6/12 week programme.
Please include GP Name, Surgery Address And Phone Number

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