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ColourMeIn
Wellbeing

Art Therapy Application and Assessment Form -
Child and Young People (Under 18)

This form is to be completed by the parent or legal guardian of the child/young person seeking art therapy. It helps ensure that therapy is appropriate and tailored to the young person’s needs. All information is treated in strict confidence and handled in accordance with HCPC and BAAT guidelines.

Child / Young Person's Details

Date of Birth
Day
Month
Year

Parent / Guardian Details

Preferred method of contact

Referral Information

Background Information

Emotional and Social Functioning

Medical and Accessibility Needs

Is there an Education, Health and Care Plan (EHCP) in place?
Yes
No

Consent

I confirm that the information provided above is accurate to the best of my knowledge. I understand this information will help the therapist assess the suitability of art therapy for my child and plan therapeutic support.
Yes
No
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