FTM Referral Form | Feel the Magic

Referrer Information

Organisation

Name

Position

Referral Capacity

Phone

Postcode

Parent/Guardian Name

Phone

Postcode

Preferred Time of Contact

Day

Time

Method of Contact

Child One

Name

Age

Gender

Child Two

Name

Age

Gender

Child Three

Name

Age

Gender

Additional Information

Bereavement History

Name

Relationship to Child/ren

When did death occur?

Cause of death

Additional Information

Consent

Is the client aware you are sharing their information with us?

Is there any other information we should be aware of before reaching out?

If you would like to schedule an appointment to discuss this referral with one of our team please use the booking form below.

Schedule an appointment

June 2025

Week starting Sunday, June 15

Time zone: Coordinated Universal Time (UTC)Phone call

Wednesday, Jun 18

10:00 AM - 11:00 AM

11:00 AM - 12:00 PM

12:00 PM - 1:00 PM

1:00 PM - 2:00 PM

To refer a family to Feel the Magic please complete the form below.