East Dunbartonshire Initiative For Creative Therapy

Therapeutic Art Sessions

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Online Referral Form

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You can complete the online referral form below, download a referral form at the bottom of the page, and send to us, or contact us and we'll send you a form.

Click on the page to download a PDF referral form.

Click on the page to download a PDF information leaflet.

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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EDICT is unable to provide support for individuals with a learning disability as their main diagnosis. Our service agreement with the East Dunbartonshire HSCP provides funding to support the groups detailed below. We are happy to discuss the referral criteria with you prior to submission.