This is a referral form to refer child client’s to The Base at Future Living. At the Base we offer a range of therapeutic services for children and young people, including, Talk Therapy, Play Therapy and Art Therapy.

Please fill in the child’s name and other information but include your contact details (phone number and email address) as the parent or carer.

Once the form is submitted, we should get back to you within 2 working days. If you do not hear back from us please email [email protected] as there may be a problem with our website.