Professional Referral Form

Here at Say More, we offer individual one to one therapy as well as the UK’s first therapy group, specifically for parents, grandparents and other family members affected by parental alienation.

If you are a professional wishing to submit a referral on behalf of someone else, please complete the following form, and we’ll be in touch.

Or if you would like to discuss a referral beforehand please drop us an email at [email protected]

Referrer’s details

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Thank you for your response. ✨

Details of individual being referred

Individual or Group Therapy?

Which type of therapy do you currently feel would be most suitable for the individual being referred?

What are the individual’s current challenges? Please tick all that apply.

If they are currently experiencing parental alienation, please tick all that apply in sections 1-5.

1. Their family role

2. Current status of their relationship with child(ren)

3. How long have they been going through parental alienation?

4. What parental alienation specific support would they like help with?

5. Our PA therapy groups run every Tuesday and Thursday evening (UK time), please select their preferred evening, if known. (See our PA therapy group FAQs for more details).

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