To apply for one of our places please complete our online form below.

Once this is submitted a member of our referrals team will be in touch to arrange completion of the application and an assessment to help review your case and provide you with a treatment plan to match your needs.

Stage 1 of 5 - Tell us about yourself

All of the following questions are about the person who needs treatment.

We need to have a telephone number that we can telephone you on to progress and/or complete your application. If you don't have a number then enter the following number into this field - 01384 241292. Once you have completed this application form, use this number (01384 241292) to call us and discuss your application.

Please indicate any and all methods of communication that you are happy for us to use to make contact with you about your application to us for treatment. We will never use any of these methods for general marketing purposes.

By ticking the I am happy to proceed check box you agree that Gordon Moody can save your personal/contact details and may use them to contact you to process your application for treatment or as part of our duty of care to you. Your personal details will be kept by us but will never be disclosed to any third party for any reason and will only be collected, used and stored in line with our privacy policy. Clicking ‘NEXT’ is confirmation that you have read and understood this statement and are happy to proceed with your application.

Gordon Moody

Find out more about Gordon Moody

If you want to find out more about what we do, how you can help personally or support us as an organisation then please get in touch and we’ll send you updates with our latest information and news.

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