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If you are aged 18 or over, are female (or identify as female) and are in need of
emotional support then we may be able to help you.
Once we receive your completed referral form, you will need to come to Chrysalis to register. Registration is every Wednesday at 11.15am and just involves registration paperwork
and getting some information about our services.
Click on the link below to open our referral form
Once you have completed the form, download it by clicking on the download button in the top right hand corner (see image below) and choosing "With your changes".
Save it to your computer / phone / tablet then open up a new email, attach the file
and send it to [email protected]
When using your phone you will need to download the free Adobe Acrobat app first.
Open the self referral form above, go to "share" and choose "Acrobat". It will then open in the app and you can complete the form on your phone
If you have problems with the PDF version, you can download a word version here.
Contact the office if you have any problems
If you are a professional and want to refer one of your clients, please complete the form below to the best of your knowledge and email it to [email protected]
You can use EGRESS free if you wish to send this information securely.
We will contact your client and arrange for them to come to Chrysalis to register with us.
If you have any problems with the PDF format you can download a Word version here
- Thank you -