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

Self 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