By completing this referral form, you’re taking the first step toward receiving support tailored to your unique journey in motherhood. This form helps us get to know you, your needs, and how best we can support you. Once submitted, your details will be added to our waitlist, ensuring your place for upcoming availability.

At Apricity Therapy, we have a team if Independent Contractors whom we can connect you with for mental health support, if you have a preference, please ensure you select below.

If you have a GP Mental Health Care Plan or any attachments applicable to this referral please attach for send this is an email to admin@apricitytherapy.com.au quoting the “Name - Referral Form Attachments”

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date Of Birth

YYYY

Referrer and Contact Info

Reason for Referral

Referral Discussed with Client

Yes

Preferred Practitioner *

Sarah Ashton

Rachel Howe

Tess Cini

No Preference

History

Please include any relevant additional information

Preferred Days

Tuesday

Wednesday

Thursday

Friday

Referral Type

I've got your referral ✨

Thank you so much for taking a leap, and trusting in me. You'll receive an email from me soon inviting you to complete our therapy intake form, please keep an eye on your inbox (and spam).

I look forward to working with you soon.

Apricity Therapy

Karratha, Western Australia

Matrescence Matters

Let’s navigate modern motherhood together.

Email Address

Thank you!

I live & work on the land of the Ngarluma & Yindjibarndi people. I acknowledge the Traditional Custodians of the land on which I practice, & pay my respects to their Elders past and present. I also take this opportunity to recognise the women who have birthed & mothered before me, & those who have held & revered the mothers of the past.

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