Outreach Booking Form

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Thank you for booking a pet therapy outreach visit with Noah's A.R.T. Please answer the following questions to enable us to provide the best possible experience for your clients. A member of the team will then be in touch as soon as possible to confirm your booking.

Email *

Type of visit booked *

Educational Outreach (schools, colleges)

Therapeutic Outreach (care homes, hospitals, community groups, mental health units)

Corporate Outreach (workplaces)

Required

Preferred time and date/s of visit/s *

Please note: visits are currently available on MONDAYS, THURSDAYS or FRIDAYS

Facility name *

Primary contact name *

Primary contact phone number *

Primary contact email address *

Facility address *

Please indicate client risk factors and needs (please tick all that apply) *

Allergies/phobias

Drugs/alcohol

Mood

Physical health

Mobility

Hearing/vision

Anxiety

Dementia/memory problems

Challenging behaviour

Other:

Required

Parking *

Free parking is available on-site

A reserved parking space is required

Paid parking is available on-site

No parking is available on-site

Other:

Preferred payment method *

Invoice

Purchase order

Other:

Please provide an email address to receive invoices and any additional information required to ensure successful invoice payment *

Please indicate any additional information you feel we should be aware of

E.g. Lateral flow test result required, door codes

I agree to adhere to Noah's A.R.T.'s safety and welfare recommendations, as described in the Noah's A.R.T. Outreach Disclaimer *

Agree

Disagree

I understand that Noah's A.R.T. operates a 24-hour cancellation policy, and that the full session fee will be due if I do not cancel at least 24 hours prior to my booked visit date *

Agree

Disagree

GDPR and data protection agreement

Noah’s ART uses your/your client's personal information to process your/your client's referral/booking and support you/your client effectively within our services. The personal information that you provide is processed and stored lawfully and in accordance with our Data Protection Policy and the Data Protection Act 2018. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds or in other ways as permitted by law.
If you/your client decide to stop working with Noah’s ART, any personal data gathered may be held for up to 12 months and then securely destroyed. In the event that you wish to withdraw your consent to us processing your/your client's personal data at any point, please contact admin@noahs-art.co.uk. *

I have read and agree to the terms above

Where did you hear about us?

Thank you for completing this booking form. A member of Noah's A.R.T. staff will be in touch as soon as possible to confirm your booking. If you have any questions or concerns, please contact admin@noahs-art.co.uk or 0161 368 6544.

A copy of your responses will be emailed to the address you provided.

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