This is a Self-Referal Form and No Need for a Doctors or School Referal.

Safeguarding Policies and Procedures.

What is Safeguarding?

A safeguarding or child protection policy is a statement that makes it clear what an organisation or group will do to keep children safe. It should include: a statement setting out the organisation's commitment to protecting all children. what the organisation will do to keep children safe and respond to concerns. About You UK has several designated trained Safeguarding Officers to ensure compliance and safety for all.

How Much Does the Service Cost?

Please be aware that we are a Charity and receives no funding from any agencies. To access the Children's Services we suggest a donation of £27.50 per session for Childrens 1 to 1, and £35.00 for Family Management to cover our operational costs (Private practice cost's from £55.00 per session). There will be an initial payment when the assessment is placed and then payments will be a week in advance of appointment.

If you have the ability to Gift Aid the charity will also benefit from this, receiving an additional 25% of your total donations.

'Donating through Gift Aid means charities and community amateur sports clubs (CASCs) can claim an extra 25p for every £1 you give. It will not cost you any extra.'

www.gov.uk

About You UK, Children & Family Referal Form

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About You UK, Children & Family Referral Form

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Childs Name: *

Date of Birth: *

Address including Postcode: *

E-mail address: *

Name of Parent or Guardian: *

Tel No: Mobile & Home *

Relationship to the Child: *

Address if Different to Child:

Doctors Name and Address *

Childs School and Pastoral Managers Name & Contact *

Can we send a letter to your current address?

Can we telephone your home number and leave a message?

Can we telephone your mobile number and leave a message?

Can we send you an e mail?

I understand that About You UK is regulated and operates Safeguarding Procedures and Policies

Has the Child been Adopted or in Care

Please give your main reason for wanting your child to receive Therapy: *

Has your child received any previous counselling/therapy? *

Are you involved with other agencies? If so, please give name of agency: *

Has your child any history of mental health issues – past/present? If so, please give details including any current medication: *

Any other relevant information including who lives in your house and their relationship to the child: (both parents, single parent, carer, foster carer, siblings, grandparents etc.) *

How were you made aware of About You UK ? *

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I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. I am aware that I can revoke my consent at any time.

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Children and Family Brochure

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