Make A Referral

By Appointment Only - please get in touch to book appointments, meetings, viewings etc. as there is not always someone in the office.

info@eatingdisorderscotland.co.uk

Glasgow and West Scotland Eating Disorders Service

your voice counts : recovery exists

Make a Referral Form

If you are an individual or organisation referring a third party individual for  one-to-one help and support, such as therapy, counselling and psychotherapy  (see Get Help and Support section here for more information on the  one-to-one services we provide),  please complete the Referrer Details and Client Details  Sections in the Make a Referral Form below to make an appointment.  Please note that all information in this form is CONFIDENTIAL. Thank you.


Please ensure you complete all sections marked * as the form will not send if these sections are not completed. Thank you.

   

Referrer Details Section

 
 
 
 
 
 
 
 
 
Client (self-funding)
Another individual (please specify below **)
Referring Organisation/Company (please specify below **)
Other (please specify below **)
 
 
Client Only
Referring Organisation/Company
Both Client and Organisation/Company
Other (please specify below **)
 
 
I confirm the above
 
 
 
 
 
 
 
 
 
 
Yes
No
 
 
Yes
No
Awaiting Treatment
 
 
 
 
 
 
CBT (Cognitive Behavioural Psychotherapy)
Integrative Therapy
General Counselling
Guided Self-Help Therapy
Online Therapy and Support
Stress Management Therapy
Coaching
Not Sure
 
Morning
Afternoon
Evening
Other (Please specify below) **
 
 
 
 

Client Details Section

Please ensure you complete all sections marked * as the form will not send if these sections are not completed. Thank you.

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