Self Referral Form

Self referral registration

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

On receipt of your self referal form, a member of our booking team will call you usually within 2 working days. 

Important

This form is only to be completed for self referrals to receive a call back from our booking team. Full payment will be take at booking confirmation. We do offer  various part payment plans, please discuss payment options within your booking call.

Please include name of referral if different to contact details
Main address for referral
Please tick as many emotional concerns as may apply?
Includes all neurotypes under the neurodiversity paradigm (i.e Autism, ADHD), Anxiety etc
Please include additional needs or disabilities or notes that will support your referral.
I agree for N.O.W.S to hold my personal information and to share with my coach / therapist only.

Any safeguarding concerns will be discussed immediately with N.O.W.S Safeguarding officer with any further investigation in accordance with the government guidelines.

I agree to my email address to be on the N.O.W.S emailing list to be updated on further supporting services / online courses.
Full payment will be taken at booking confirmation. (We do offer various part payment plans, please discuss payment options within your booking call)

This consent must be given for all family members before any sessions begin (this includes consent for all individuals under the age of 16 from the parent/career).

You are accountable to respectfully show up on time for each session to learn some wellbeing tools & techniques with a holistic approach that will coached / mentored via the N.O.W.S team.

As parents/carers you are also responsible to ensure any children are present on time for each session, passing information onto the school if the sessions are being facilitated within school hours.

If for any reason a session cannot be attended on the time / date booked, a 24 hours notification prior to the session is required by you (or this will be deemed as a missed session 'no show'). Please notify the N.O.W.S team by directly messaging via your dashboard, or emailing bookings@nows.org.uk or by freephone 0345 366 9755, where we will reschedule sessions.

If less than 24hours notification is provided, any missed session 'no show' will not refunded.

If at any time you no longer wish to continue with the programme or therapy a refund will be provided for any remaining sessions at N.O.W.S discretion and must fall within 24 hours notice of any remaining sessions.
By submitting this form you are agreeing that N.O.W.S can contact you to discuss your referral on the contact details provided.
If you are having an aromatherapy consultation; I consent for the aromatherapy blend to be made from the information that I provide either during the consultation or by completing the clinical aromatherapy form.

I confirm that any information I have provided is true to best of my knowledge and belief.
School contact consent (only if you child is having an in-school session)

I agree for N.O.W.S admin team to reset any passwords, to be passed onto the school directly if my child is not able to connect with their coach for in-school sessions (NB you will receive an email to confirm a new password has been set up).
N.O.W.S will contact the school and arrange for any sessions to be facilitated during school term time.

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