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Eggtooth

Online referral form

Fees for Services

£55 per one-hour session (50 minutes for clinical sessions)

Please note that sessions are payable in advance.

If you are seeking support for a child (under 18) and are registered with doctors in the
Hastings and St Leonards Primary Care Network you may be eligible for up to 8 funded
sessions. Please contact your GP for eligibility and to be referred.

    Referral Details

    Is this a self-referral?

    Are you seeking support for someone else?

    If yes,

    Client Details

    Parent/Carer Details (if under 18 and not the referrer)

    Is parent/carer aware of the referral?

    Have they given consent to be contacted by Eggtooth?

    Session Preferences

    Preferred Format

    Preferred Practitioner:

    Availability: (Tick all that apply)

    Services Available

    Counselling & Therapy (For those wishing to speak with a qualified professional about their mental health.)

    Creative Wellbeing (Live and interactive sessions led by professional artists and creative practitioners. Please tick all that apply.)

    Presenting Needs and Goals



    Health and Support Information

    1. Are there any other services currently involved?


    2. Emergency Contact Details

    (Please provide the name and telephone number of a next of kin, social worker, or key worker.)



    3. Are there any risk factors we should be aware of? (Please tick all that apply and provide further details below.)


    4. Am I/the client currently receiving therapy or counselling, or have I/they done so in the past?


    5. Health Information



    6. Employment & Education

    7. Household Information

    8. Is there anything else you feel we should know?

    Additional Information

    How would you like us to contact you? (Please tick one or more)

    We have been made aware that emails from The Eggtooth Project (info@eggtooth.org.uk) are sometimes marked as spam. Please check your junk folder if you have not heard from us within two weeks.

    Data Use and Permissions

    By submitting this referral form, you confirm that:

    • You have the necessary consent to share this information with Eggtooth, including consent from the young person (where appropriate) and/or their parent/carer.

    • The information provided is accurate to the best of your knowledge.

    • You understand that Eggtooth will use this information solely to assess and provide appropriate services.

    • Eggtooth will store this information securely and may share it, where necessary, with relevant professionals involved in the young person’s care, but only with appropriate consent or where required by law (e.g. safeguarding).

    booking-form

    Client Testimonials

    "Therapy is a godsend, regardless of whether you think you need it or not.”
    Alex

    "I'm less anxious, have less horrible thoughts, better mood, more positive outlook and thought process, sleep improved slightly too."
    Liam

    "The support I received was incredible. The therapist was understanding, patient, and truly cared about my progress. I recommend this service to everyone.”
    Aja