Individual AAA referral form - At Birkhill House

AAA Individual Referral Form

Animal Assisted Activity (AAA) sessions At Birkhill House CIC are flexible and fluid, taking into account the needs of the individual, the seasons and the environment. Sessions could involve an afternoon in the company of Ragdoll cats, a walk through the fields with the goats or alpacas or spending time with the chickens. It will largely depend on what is right for the visiting individual. To that end, we would like to ask for a bit more information before scheduling an introductory session...

You can fill in the form and submit it below, or if you would prefer to download, print and post a paper copy, you can download a form here.

Name of individual: *

Is this referral for a young person (under 18) or an adult? *

Phone number: *

Email *

Are you referring for someone else? *

If yes, please give your name:

Your relationship to the individual:

Interests of the individual:

This is important so that we can try to match appropriate animals in a proposed programme of visits.

Specific requirements:

This is your space to explain why you are interested in an AAA session. You can include information about any health-related issues or diagnoses and also more informal observations surrounding your interest. It would be useful to know if the individual has any allergies, phobias or additional needs.

What would you like to achieve through your AAA sessions here? Are there specific outcomes?

We would like to chat to you a bit more after we have read through your answers. When would be a good time to call?

How did you hear about us?

After we have received your information and followed up with a further chat, if you decide to go ahead we can offer an introductory session to gauge the fit and map a path of activities suitable to your needs.

Prices

An introductory session cost £20 each and lasts for about a half hour.

Thereafter the hourly rate for regular sessions is £25.

contact

Birkhill House

Earlston TD4 6AR

email & phone

lara_armitage@hotmail.com

07779 339 653