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 within 48 hours. 

Private therapy enquiry form

Your details
Who are you enquiring about our private therapy service for?
Your child's information
Does your child have a diagnosis of Cerebral Palsy? *
Has your child had therapy with Cerebral Palsy Cymru before? *
How recently has your child attended therapy with Cerebral Palsy Cymru? *
Your enquiry
Do you have a diagnosis of Cerebral Palsy? *
Have you had therapy with Cerebral Palsy Cymru before? *
How recently did you attend therapy with Cerebral Palsy Cymru? *
Client information
Client information *
Has your client had therapy with Cerebral Palsy Cymru before? *
How recently has your client attended therapy with Cerebral Palsy Cymru? *
Enquiry on behalf of someone else
Age and diagnosis of individual *
Has this individual attended therapy at Cerebral Palsy Cymru before? *
How recently has this individual attended therapy with Cerebral Palsy Cymru? *
Therapy preferences
What type of therapy do you feel would be most appropriate at this time? (Please tick all that apply) *
What days of the week would be most suitable for therapy? (Please tick all that apply) *
Would morning or afternoon appointments be more suitable? *
What style of session would be most convenient? *
How did you find out about our service?
How did you find out about our private therapy 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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