Autism Together Talking Therapies Enquiry Form

General information about our Autism Talking Therapies is available on a separate leaflet. Please note: we do not offer advice on finances, form filling or admissions into care services - but we may signpost.

Age of individual

Other services

Does the individual receive support from other services?

Please note - these Talking Therapy Sessions are only available to individuals receiving little to no professional support from other services.

Who has made the referral?

(Tick the box that apply)

Referral

(details of individual who is being referred)

Person making the referral

(If different to referral details)

Reason for attending

You may be accompanied to the session by an adult.

A session will be scheduled but there is a waiting list.

Your session may be cancelled or rearranged at the discretion of Autism Together, should there be a need to and an alternative date and time will be given.

If for any reason you cannot attend the session please let us know as soon as possible on 0151 482 3145 or by email to: ATAS.Dept@autismtogether.co.uk

This means that you will be put back onto the waiting list due to the high demand for sessions. This will enable us to use the session time with another individual who needs it.

General Data Protection Regulations: The person(s) participating in this session agree for this information to be kept and stored electronically. This will be done confidentially and may be deleted permanently at any time under the wishes of the main participant.

Thank you

Autism Together Advisory Service

Wirral Centre for Autism, Oak House, 6 Tebay Road Bromborough, Wirral CH62 3PA