{"id":7196,"date":"2022-08-05T07:50:39","date_gmt":"2022-08-05T06:50:39","guid":{"rendered":"https:\/\/4winds.org.uk\/?page_id=7196"},"modified":"2025-03-31T18:50:45","modified_gmt":"2025-03-31T17:50:45","slug":"referralform","status":"publish","type":"page","link":"https:\/\/4winds.org.uk\/ur\/referralform\/","title":{"rendered":"ReferralForm"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7196\" class=\"elementor elementor-7196\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-800ea1c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"800ea1c\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c4f06b4\" data-id=\"c4f06b4\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0817f72 elementor-cta--skin-classic elementor-animated-content elementor-bg-transform elementor-bg-transform-zoom-in elementor-widget elementor-widget-call-to-action\" data-id=\"0817f72\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"call-to-action.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-cta\">\n\t\t\t\t\t\t\t<div class=\"elementor-cta__content\">\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<h2 class=\"elementor-cta__title elementor-cta__content-item elementor-content-item\">\n\t\t\t\t\t\tREFERRAL FORM\t\t\t\t\t<\/h2>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-cta__description elementor-cta__content-item elementor-content-item\">\n\t\t\t\t\t\tIf you would like to refer somebody or make a self-referral to our services, please complete the form below.  Alternatively call us to discuss: <span style=\"font-size: 18px;font-style: normal;font-weight: 400\">02920 388144.<\/span><br><br>Our person centered, recovery focussed mental health services are available to anyone over the age of 16 living in Cardiff and the Vale and include the following: <br>\nOpportunities for social contact and peer support, emotional support, recovery star sessions, guided self help (CBT), groups, training and courses, sign posting and social prescribing and assistance with welfare benefits.\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-409b91f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"409b91f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fd5336a\" data-id=\"fd5336a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ed1803a elementor-widget elementor-widget-wpforms\" data-id=\"ed1803a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container \" id=\"wpforms-7195\"><form id=\"wpforms-form-7195\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"7195\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/ur\/wp-json\/wp\/v2\/pages\/7196\" data-token=\"34350f76c5145b84069f61c8c1e7f3d0\" data-token-time=\"1775293077\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-7195-field_18-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"18\"><label class=\"wpforms-field-label\">Name (person referring, or self): <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-7195-field_18\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][18][first]\" required><label for=\"wpforms-7195-field_18\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7195-field_18-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][18][last]\" required><label for=\"wpforms-7195-field_18-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-7195-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-7195-field_28\">Name of Organisation (if applicable):<\/label><input type=\"text\" id=\"wpforms-7195-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" ><\/div><div id=\"wpforms-7195-field_21-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-7195-field_21\">Phone Number (person referring): <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-7195-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" step=\"any\" required><\/div><div id=\"wpforms-7195-field_22-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"22\"><label class=\"wpforms-field-label\">Name (person referred):   <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-7195-field_22\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][22][first]\" required><label for=\"wpforms-7195-field_22\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7195-field_22-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][22][last]\" required><label for=\"wpforms-7195-field_22-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-7195-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-7195-field_5\">Date of Birth of (person referred): <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7195-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-7195-field_23-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-7195-field_23\">Contact Number (person referred): <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-7195-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" step=\"any\" required><\/div><div id=\"wpforms-7195-field_26-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-7195-field_26\">Address (person referred): <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-7195-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" required><\/textarea><\/div><div id=\"wpforms-7195-field_24-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-7195-field_24\">Email (person referred):<\/label><input type=\"email\" id=\"wpforms-7195-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-7195-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-7195-field_25\">GP Surgery (person referred):   <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7195-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" required><\/div><div id=\"wpforms-7195-field_27-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-7195-field_27\">Reason for referral\/How can we help you? Please include any relevant background information, physical health issues and any risks to self, others or staff. <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-7195-field_27\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][27]\" required><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"7195\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/pages\/7196\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-7195\" class=\"wpforms-submit\" data-alt-text=\"Sending\u2026\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/4winds.org.uk\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>REFERRAL FORM If you would like to refer somebody or make a self-referral to our services, please complete the form below. Alternatively call us to discuss: 02920 388144. Our person centered, recovery focussed mental health services are available to anyone over the age of 16 living in Cardiff and the Vale and include the following: [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-7196","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/pages\/7196","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/comments?post=7196"}],"version-history":[{"count":22,"href":"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/pages\/7196\/revisions"}],"predecessor-version":[{"id":7802,"href":"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/pages\/7196\/revisions\/7802"}],"wp:attachment":[{"href":"https:\/\/4winds.org.uk\/ur\/wp-json\/wp\/v2\/media?parent=7196"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}