Below is a secure referral form provided by our client management software so any and all information provided will be managed securely and confidentiality maintained.

Note: Before you start completing the form, please be sure that your browser is up to date or else the form submission may not work (Chrome is the preferred browser but others should also work).

Alternatively, use the contact us form on the previous page to start a conversation with us and we can collect the information necessary.

Note: If you press the submit button and nothing changes on the screen or you do not receive a thank you message, please check that:

• You have completed all of the required fields. And

• Your browser is up to date.

Alternatively, you can:

• Try and complete the form on the Chrome browser. Or

• Copy and paste the information you’ve put into the above form into a word document and email it to hello@birdsofafeather.health. Or

• Use the contact us form on the previous page to start a conversation with us and we can collect the information necessary.