Booking form - Eggtooth

Your First name:

Your Last name:

Clients First name:

Clients Last name:

Date of birth:

Address 1:

Address 2:

City

State/Province:

Zip/Postal Code:

Country:

Your contact number:

Email:

Parent/Carer Contact Numbers (where applicable):

Date of Referral:

Reason for Referral:

If you are under 14, please tick here to confirm that your Parent/Carer has consented.

For anyone wishing to talk to a qualified professional about your mental health.

Live and interactive, delivered by professional artists and practitioners. Tick which activities you are interested in.

Music and SongwritingArt and MakingCookingBoxingSpoken Word and Creative Writing workshopsWalking with Horses

All of our skilled Practitioners hold an Enhanced DBS. For more information, please refer to our GDPR and online policies on the Eggtooth website.

We have been made aware that emails from The Eggtooth Project (info@eggtooth.org.uk) are often being marked as spam. Please be sure to check your junk folder if you haven’t heard from us within a week.

Please note that the information provided on this form will be stored on our system so that we can contact you about your referral. Our GDPR Policy is available to view on our “Policies” page.

Online referral form

Fees for Services

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