Confidentiality Statement

Please note that this referral form is intended for individuals and couples aged 16 and over.

Any information you share with the therapists at The Wee Therapy Rooms (TWTR) will be treated confidentially and stored securely in accordance with GDPR and data protection legislation.

Information will not be shared with anyone outside of The Wee Therapy Rooms without your consent, except in exceptional circumstances where there is a serious risk of physical, emotional, or sexual harm to yourself or others, or where disclosure is required by law.

I have read and understood the confidentiality statement above.
How did you hear about us?
Name
Identified Gender
Age Range
If this is not a self-referral but you are referring on behalf of someone please complete the referrer section below.
Referrer's name
Is/are the individuals aware of this referral?
What's your preferred method of therapy that you are looking to engage with
Which therapist would you like to have sessions with?
You can find out more about our practitioners here: theweetherapyrooms.com/about/
How would you like to be contacted?