Curious Minds
This programme supports people aged 18 or over in Ipswich and East Suffolk living with complex
health needs.

You can be referred to our Curious Minds programme by your GP or social prescriber. Or you can
self-refer by completing our online referral form.

We will then give you a call to check that this activity is right for you, and answer any questions you
may have.

If you have any queestions or need help completeing this form please call Jen on 0751 448 417 or email

jen@suffolkartlink.org.uk

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Name *
Address
Postcode
Date of Birth
MM
/
DD
/
YYYY
NHS Number
Telephone (day):
 *
Mobile
GP Surgery
Ethnicity
Gender
Do you consent to the referral?
Please let us know briefly about any health challenges you are currently living with. This information
will be kept strictly confidential.
Please let us know if you have any access needs or allergies that we should be aware of.
How did you hear about Curious Minds?
Clear selection
Thank you for completing this form.
We will give you a call soon to check that this is the right activity for you and answer any questions
you may have about these sessions.

Suffolk Artlink is a registered charity no. 1110898 and a company limited by guarantee registered in England and Wales No. 05354844. Registered office: Units 13 & 14, Malt Store Annex, The Cut, 8 New Cut, Halesworth, IP19 8BY Data protection No. Z2348150
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