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Say Hello

Below is an application for the Stella McCartney x Operation Centaur equine-assisted psychotherapy programme. Working with horses offers a powerful route to safety, connection and the confidence to move forward, often reaching places that talking therapy alone cannot. 

Please take your time completing the form below; your answers help us understand how we might best support you.

Due to the high volume of submissions we receive, we’re unable to respond to every applicant individually. If we’re able to offer you a place, you can be sure that we’ll be in touch.

Stella McCartney X Operation Centaur

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Confidentiality statement

Thank you for your interest in our equine assisted psychotherapy programme. Please complete this form as fully as possible. All information will be treated confidentially and used solely to assess your suitability for the programme.

  1. Applicant details

Date of birth
Day
Month
Year
Multi-line address
Preferred method of contact
Phone
Email
Text Message
  1. Referral information

How did you hear about our service?
GP
Mental Health Professional
Social Worker
School/ College
Charity
Family/ Friend
Stella McCartney Campaign
Social Media
Internet search
Other
Referring professional (if applicable)
  1. About you

What brings you to equine therapy (select all that apply)?
  1. Health information

Have you ever been diagnosed with any neurodevelopmental or mental health condition?
No
Yes
Are you currently receiving:

Relevant physical health conditions:

Do you have any physical health conditions, allergies, or injuries that are relevant to this application or that we should be aware of to support your safety and well-being?
No
Yes
  1. Safety information

Have you experienced any of the following within the past six months?
Do you currently feel safe?
  1. Accessibility

  1. Means testing (financial assessment)

This section helps us determine your suitability for subsidised sessions. Supporting evidence may be requested should your application be successful.

Employment status
Full-time employment
Part-time employment
Self-employed
Unemployed
Student
Retired
Unable to work due to illness/ disability
Gross Annual Household Income
Under £20,000
£20,000 - £30,000
£30,001 - £40,000
£40,001 - £50,000
£50,001 - £75,000
over £75,000
Benefits received (please tick all that apply)
Housing status
Owned: Owns outright
Owned: Owns with a mortgage or loan
Shared ownership: Shared ownership
Social rented: Rents from council or Local Authority
Social rented: Other social rented
Private rented
Living rent free
  1. Consent

I understand that:


  • The information provided is accurate to the best of my knowledge.

  • Completing this form does not guarantee acceptance into the programme.

  • My information will be processed in accordance with applicable data protection legislation.


I agree that the therapist may contact my referring professional (where applicable) with my consent.

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Date
Day
Month
Year

Copyright © 2024 Operation Centaur

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