Make a referral to Kerryn Knight - Art Therapist

Wanting to make a referral to Kerryn Knight – Arts Therapist & Founder of Empowered Art Therapy & Kindred Art Space?

You can call Kerryn directly on 0450 253 990 to discuss your needs or those of someone you want to refer. Or you can make an online referral via the form below:

Contact Therapist

Name*
Date of Birth*
DD slash MM slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address*
Enter Email Confirm Email
Phone Number*
Do you have a referring agency?*
- Yes
- No
Referring Agency Contact Name*
Referring Agency Contact Email*
Enter Email Confirm Email
Referring Agency Contact Phone*
Do you have an NDIS plan?*
- Yes
- No
NDIS Plan Number*
NDIS Plan Manager Details*
Please provide any information about disability, chronic medical, or mental health condition?*
Do you have a care team and/or access other supports in relation to your mental health and wellbeing?*
- Yes
- No
Please list care team and/or other supports you currently access for your mental health and wellbeing.*
Is there something you wish to disclose to our Arts Therapists regarding your mental health and wellbeing?*
What are your goals for therapy?*
Phone
This field is for validation purposes and should be left unchanged.