Melbourne Art Therapy form

MELBOURNE ART THERAPY STUDIO
Abbotsford Convent Arts Precinct
Convent Building
Studio C2.26 1 St Heliers Street
Abbotsford Vic 3067
Ph: (03) 8415 0052

info@melbournearttherapy.com.au

General registration form

Registration form for Introduction to art therapy please click here

Group / Workshop
Day & Time
Day:
Term:
Name:
Address
Date of Birth
Day:
 Month:
 Year:

Phone (home):

Phone (mobile)
Email
What are you hoping to get out of the art therapy group?

Would you like to work on any of the following areas?

 Confidence & self-esteem
Anxiety
Depression
Anger
Stress & relaxation
Sexuality & gender
Trauma
Addictions
Personal development
Communication
Trust
Managing conflict
Intimacy/sexual problems
Parenting
Separation
Divorce
Blended families
Step-parenting
Is there anthing you would like your facilitator to know? eg: Illness, disability, chronic pain. Please specify.
Are you currently having treatment for your illness? Please specify. eg. medication, other forms of therapy.
Where did you hear about us?
I have read and accept the TERMS & CONDITIONS of registration Yes





Please include your name & group in the reference field.

BSB: 013 236
Account Number: 901008851
Account Name: Melbourne Art Therapy Studio

Payments can also be made at any ANZ bank

 

 'Payment must be made in full by the start of the first session'


PLEASE ORGANISE PAYMENT BEFORE SUBMITTING FORM