Private therapy enquiry form

All our private therapy sessions will be conducted by one of our highly specialist therapists who all have extensive experience working with children, young people and adults who have cerebral palsy.

To enquire about our private therapy services, please complete this short form and a member of our team will get back to you as soon as possible. 

Private therapy enquiry form

Your details
Who are you enquiring about our private therapy service for? *
What is your relationship to this person? *
Client/Child's information
Please note our private therapy service is for children, young people and adults over the age of 2. If your child is under 2, please contact us about our Early Intervention Service (Better Start Better Future) instead.
Do they have a diagnosis of Cerebral Palsy? *
Have they had therapy with Cerebral Palsy Cymru before? * Please note if they are a new client/child, an initial consultation will be required in the first instance.
How recently have they attended therapy with Cerebral Palsy Cymru? * Please note if you have not attended therapy within the last 12 months, an initial consultation will be required in the first instance.
What type of therapy do you feel would be most appropriate at this time? * Please tick all that apply We will do our best to meet these needs
This information will help us understand their needs prior to us contacting you
Therapy preferences
What style of session would be most convenient? *
e.g. 1st session in person, next 4 video call
What type of therapy session would you like to book? *
What type of therapy session would you like to book? * Please note; An initial consultation is required for all new clients/children or those returning after more than 12 months. Further appointment types will be available following an initial consultation if deemed appropriate for the clients/child's needs.
Do you require a written report following the therapy sessions? A written report is an additional cost
What days of the week would be most suitable for therapy? * Please tick all that apply Please note our therapists typically do not work on Mondays
What time slots for appointments would be most suitable? (Please tick all that apply) *
How would you prefer therapy sessions to be spaced out? *
The more detail you give now, the simpler it will be to process your request. E.g. Specific dates or months you are looking for, times you are unavailable on certain days of the week, school holidays and so on.
E.g. Payment via a solicitor, payment via a charity
How did you find out about our service?
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Cerebral Palsy Cymru
Therapy and support for children and their families

Cerebral Palsy Cymru is a registered charity in England and Wales 1010183. A company limited by guarantee. Registered company in England and Wales 02691690. Registered address: Cerebral Palsy Cymru, 1 The Courtyard, 73 Ty Glas Avenue, Llanishen, Cardiff, CF14 5DX.

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