East Dunbartonshire Initiative for Creative Therapy

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Therapeutic Art Sessions

Providing access & support for individuals in East Dunbartonshire

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MAKE A

REFERRAL

Accessing Our Services

Referrers name
Organisation
Referrer e-mail
Referrer phone number
Participants forename:
Participants surname:
Date of Birth
Address
Town Kirkintilloch
Bishopbriggs
Milngavie
Bearsden
Milton of Campsie
Twechar
Lennoxtown
Lenzie
Torrance
Post code
Participant phone:
Participant mobile phone:
Participant e-mail
Participant health condition:
Reasons for referral:
Do you attend any other support services? - If yes please list them
Emergency contact name:
Relationship to participant:
Emergency contact phone number:

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Anyone can make a referral to EDICT. Either complete the form below or download a referral form and post it us. If you have any questions please do not hesitate to contact us. You can also download our information leaflet below the form.

Prior to completing this form please ensure you have permission to share the individuals data.

Referral Form

Information Leaflet