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Hello and welcome to the Physical Empowerment referrals page.

You can use the forms on this page to refer yourself or someone else for a Physical Empowerment course. Please ensure that you fill out all the sections and put as much detail as possible. All information received is confidential and will not be shared.

If you would rather complete the referral over the phone, please use either of the numbers on the contact page.

Please note, we do not work with anyone who is in a current relationship with a known perpetrator. This is for everybody’s safety.

If you are referring someone else to our service, please fill out your information in the top part of the form below, and then also complete the second part of the form.
If you are referring yourself, please miss out the first bit and jump to 'Client Details', a bit further down the form.

Referrer Details

Client Details

We try and ensure that our courses are as accessible as possible and we have a small budget for childcare and travel for women who need it. Will you / the person you are referring need the following in order to attend the course:

Child Provision Required
Travel Allowance Required

Thanks for completing the referral form. We'll be in touch soon.

Please complete the client details below. Please also complete this part of the form if you are referring yourself.

Course Information

All of our courses are twelve weeks; an introductory session, the ten-week course and a debrief session. We then offer regular follow-up sessions to those who are able to attend.

We ask that people work hard to attend every session so they get the maximum benefit from the course.

Port Talbot: courses run on Tuesday mornings in Sandfields, from 10am – 12pm. Our next introductory session and course will be in May 2024.

Llanelli: We will be running another course here in May 2024. 

Please get in touch if you wish to refer someone but your area is not listed. We do offer one-to-one sessions but these often require specific funding. 

If you have any specific questions, please get in touch using our contact page.

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