Location and Contact Contact us in confidence using the form below, or This email address is being protected from spambots. You need JavaScript enabled to view it. Confidential referral form We can accept private referrals from you or your family, and referrals from all care professionals. Name * Name of your child * Date of birth (of person seeking assessment/treatment) * Email address * Phone Number * Your message * Where did you hear about us? * Send message Website