{"id":4005,"date":"2020-11-11T12:38:30","date_gmt":"2020-11-11T12:38:30","guid":{"rendered":"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005"},"modified":"2021-06-02T09:58:38","modified_gmt":"2021-06-02T09:58:38","slug":"referral-form","status":"publish","type":"page","link":"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005","title":{"rendered":"Referral Form"},"content":{"rendered":"<section class=\"l-section wpb_row us_custom_7c1d7e70 height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_middle\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column us_custom_e0b2fa3c has_text_color\" ><div class=\"wpb_wrapper\"><p>FORMS<\/p>\n<\/div><\/div>[vc_custom_heading source=&#8221;post_title&#8221; font_container=&#8221;tag:h1|text_align:left&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;%7B%22default%22%3A%7B%22color%22%3A%22%23ffffff%22%2C%22font-size%22%3A%2230pt%22%7D%7D&#8221;]<\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_top\"><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column\" ><div class=\"wpb_wrapper\"><p>Referral form for you to print and return to us is below.<\/p>\n<\/div><\/div><div class=\"w-separator size_custom\" style=\"height:40px\"><\/div><div class=\"w-btn-wrapper width_auto align_left\"><a class=\"w-btn us-btn-style_1\" target=\"_blank\" href=\"https:\/\/familymediationbarnsley.co.uk\/wp-content\/uploads\/2021\/06\/Referral0621_blank.pdf\" rel=\"noopener\"><span class=\"w-btn-label\">REFERRAL FORM<\/span><\/a><\/div><div class=\"w-separator size_custom\" style=\"height:40px\"><\/div><div class=\"wpb_text_column\" ><div class=\"wpb_wrapper\"><p>Alternatively, complete your details on our online referral form and it will be emailed directly to us.<\/p>\n<p>If you would like to complete the form online, please complete the form fields, these will populate into the correct areas of the agreement and will be sent to us electronically. You will also receive an email with a copy for your reference.<\/p>\n<\/div><\/div><div class=\"w-separator size_custom\" style=\"height:40px\"><\/div><\/div><\/div><\/div><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"g-cols wpb_row  us_custom_400b32b7 type_default valign_top vc_inner has_border_radius\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-separator size_custom\" style=\"height:20px\"><\/div><div class=\"wpb_text_column us_custom_ed03a097\" ><div class=\"wpb_wrapper\"><p>Referral &#8211; Form<\/p>\n<\/div><\/div><div class=\"w-separator size_custom\" style=\"height:20px\"><\/div>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4018-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F4005#wpcf7-f4018-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"4018\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4018-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><strong>YOUR DETAILS<\/strong>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"YourDetails-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Name\" value=\"\" type=\"text\" name=\"YourDetails-Name\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"YourDetails-AddressLine1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Address Line 1\" value=\"\" type=\"text\" name=\"YourDetails-AddressLine1\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"YourDetails-AddressLine2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Address Line 2\" value=\"\" type=\"text\" name=\"YourDetails-AddressLine2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"YourDetails-HomeTel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Home Telephone\" value=\"\" type=\"text\" name=\"YourDetails-HomeTel\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"YourDetails-Mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Mobile\" value=\"\" type=\"text\" name=\"YourDetails-Mobile\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"YourDetails-Email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Email\" value=\"\" type=\"text\" name=\"YourDetails-Email\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"YourDetails-DOB\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Date of birth\" value=\"\" type=\"text\" name=\"YourDetails-DOB\" \/><\/span>\n<\/p>\n<p><strong>OTHER PARTY DETAILS<\/strong>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"OtherPartyDetails-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"OtherPartyDetails-Name\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"OtherPartyDetails-AddressLine1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Address Line 1\" value=\"\" type=\"text\" name=\"OtherPartyDetails-AddressLine1\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"OtherPartyDetails-AddressLine2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Address Line 2\" value=\"\" type=\"text\" name=\"OtherPartyDetails-AddressLine2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"OtherPartyDetails-HomeTel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Home Telephone\" value=\"\" type=\"text\" name=\"OtherPartyDetails-HomeTel\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"OtherPartyDetails-Mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Mobile\" value=\"\" type=\"text\" name=\"OtherPartyDetails-Mobile\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"OtherPartyDetails-Email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Email\" value=\"\" type=\"text\" name=\"OtherPartyDetails-Email\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"OtherPartyDetails-DOB\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Date of birth\" value=\"\" type=\"text\" name=\"OtherPartyDetails-DOB\" \/><\/span>\n<\/p>\n<p><strong>CHILDREN'S NAMES<\/strong>\n<\/p>\n<div class='content-column full_width'><div style=\"padding-top:10px;padding-right:5px;padding-bottom:5px;\">CHILD 1<\/div><\/div><br \/>\n<div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child1-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"Child1-Name\" \/><\/span><\/div><\/div><div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child1-DOB\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Date of Birth\" value=\"\" type=\"text\" name=\"Child1-DOB\" \/><\/span><\/div><\/div><div class='content-column one_third last_column'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child1-LivingWith\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Who do they live with?\" value=\"\" type=\"text\" name=\"Child1-LivingWith\" \/><\/span><\/div><\/div><div class='clear_column'><\/div>\n<div class='content-column full_width'><div style=\"padding-top:10px;padding-right:5px;padding-bottom:5px;\">CHILD 2<\/div><\/div><br \/>\n<div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child2-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"Child2-Name\" \/><\/span><\/div><\/div><div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child2-DOB\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Date of Birth\" value=\"\" type=\"text\" name=\"Child2-DOB\" \/><\/span><\/div><\/div><div class='content-column one_third last_column'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child2-LivingWith\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Who do they live with?\" value=\"\" type=\"text\" name=\"Child2-LivingWith\" \/><\/span><\/div><\/div><div class='clear_column'><\/div>\n<div class='content-column full_width'><div style=\"padding-top:10px;padding-right:5px;padding-bottom:5px;\">CHILD 3<\/div><\/div><br \/>\n<div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child3-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"Child3-Name\" \/><\/span><\/div><\/div><div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child3-DOB\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Date of Birth\" value=\"\" type=\"text\" name=\"Child3-DOB\" \/><\/span><\/div><\/div><div class='content-column one_third last_column'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child3-LivingWith\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Who do they live with?\" value=\"\" type=\"text\" name=\"Child3-LivingWith\" \/><\/span><\/div><\/div><div class='clear_column'><\/div>\n<div class='content-column full_width'><div style=\"padding-top:10px;padding-right:5px;padding-bottom:5px;\">CHILD 4<\/div><\/div><br \/>\n<div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child4-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"Child4-Name\" \/><\/span><\/div><\/div><div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child4-DOB\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Date of Birth\" value=\"\" type=\"text\" name=\"Child4-DOB\" \/><\/span><\/div><\/div><div class='content-column one_third last_column'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child4-LivingWith\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Who do they live with?\" value=\"\" type=\"text\" name=\"Child4-LivingWith\" \/><\/span><\/div><\/div><div class='clear_column'><\/div>\n<div class='content-column full_width'><div style=\"padding-top:10px;padding-right:5px;padding-bottom:5px;\">CHILD 5<\/div><\/div><br \/>\n<div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child5-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"Child5-Name\" \/><\/span><\/div><\/div><div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child5-DOB\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Date of Birth\" value=\"\" type=\"text\" name=\"Child5-DOB\" \/><\/span><\/div><\/div><div class='content-column one_third last_column'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child5-LivingWith\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Who do they live with?\" value=\"\" type=\"text\" name=\"Child5-LivingWith\" \/><\/span><\/div><\/div><div class='clear_column'><\/div>\n<div class='content-column full_width'><div style=\"padding-top:10px;padding-right:5px;padding-bottom:5px;\">CHILD 6<\/div><\/div><br \/>\n<div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child6-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"Child6-Name\" \/><\/span><\/div><\/div><div class='content-column one_third'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child6-DOB\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Date of Birth\" value=\"\" type=\"text\" name=\"Child6-DOB\" \/><\/span><\/div><\/div><div class='content-column one_third last_column'><div style=\"padding-right:5px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"Child6-LivingWith\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Who do they live with?\" value=\"\" type=\"text\" name=\"Child6-LivingWith\" \/><\/span><\/div><\/div><div class='clear_column'><\/div><br \/>\n<strong>ISSUES TO BE DISCUSSED WITHIN MEDIATION (please select)<\/strong>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ISSUESTODISCUSS\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"ISSUESTODISCUSS\" value=\"Children Issues\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Children Issues<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"ISSUESTODISCUSS\" value=\"Financial Issues\" \/><span class=\"wpcf7-list-item-label\">Financial Issues<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"ISSUESTODISCUSS\" value=\"Children &amp; Financial Issues\" \/><span class=\"wpcf7-list-item-label\">Children &amp; Financial Issues<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><strong>WHICH IS YOUR CLIENT'S PREFERRED LOCATION FOR MEDIATION? (please select)<\/strong>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"PreferredLocation\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"PreferredLocation\" value=\"Wakefield\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Wakefield<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"PreferredLocation\" value=\"Leeds\" \/><span class=\"wpcf7-list-item-label\">Leeds<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"PreferredLocation\" value=\"Huddersfield\" \/><span class=\"wpcf7-list-item-label\">Huddersfield<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"PreferredLocation\" value=\"Halifax\" \/><span class=\"wpcf7-list-item-label\">Halifax<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"PreferredLocation\" value=\"York\" \/><span class=\"wpcf7-list-item-label\">York<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"PreferredLocation\" value=\"Scarborough\" \/><span class=\"wpcf7-list-item-label\">Scarborough<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"PreferredLocation\" value=\"Barnsley\" \/><span class=\"wpcf7-list-item-label\">Barnsley<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"PreferredLocation\" value=\"Online\" \/><span class=\"wpcf7-list-item-label\">Online<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div class='content-column full_width'><div style=\"padding-top:30px;padding-right:5px;padding-bottom:5px;\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SUBMIT FORM\" \/><\/div><\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<div class=\"w-separator size_custom\" style=\"height:20px\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row us_custom_462914df height_auto width_full\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_middle\"><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner us_custom_528b58c5\"><div class=\"wpb_wrapper\">[vc_custom_heading text=&#8221;Do you have any questions?&#8221; font_container=&#8221;tag:p|text_align:left&#8221; google_fonts=&#8221;font_family:Dancing%20Script%3Aregular%2C700|font_style:400%20regular%3A400%3Anormal&#8221; css=&#8221;%7B%22default%22%3A%7B%22color%22%3A%22%23ffffff%22%2C%22font-size%22%3A%2217pt%22%2C%22margin-left%22%3A%220px%22%2C%22margin-top%22%3A%220px%22%2C%22margin-bottom%22%3A%220px%22%2C%22margin-right%22%3A%220px%22%2C%22padding-left%22%3A%220px%22%2C%22padding-top%22%3A%220px%22%2C%22padding-bottom%22%3A%220px%22%2C%22padding-right%22%3A%220px%22%7D%7D&#8221;]<div class=\"wpb_text_column us_custom_8f270d47 has_text_color\" ><div class=\"wpb_wrapper\"><h2>Contact me now<\/h2>\n<\/div><\/div><\/div><\/div><\/div><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner us_custom_528b58c5\"><div class=\"wpb_wrapper\"><div class=\"w-btn-wrapper width_auto align_right\"><a class=\"w-btn us-btn-style_2\" title=\"Contact\" href=\"https:\/\/familymediationbarnsley.co.uk\/contact\/\"><span class=\"w-btn-label\">Contact Us<\/span><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"FORMS [vc_custom_heading source=\"post_title\" font_container=\"tag:h1|text_align:left\" use_theme_fonts=\"yes\" css=\"%7B%22default%22%3A%7B%22color%22%3A%22%23ffffff%22%2C%22font-size%22%3A%2230pt%22%7D%7D\"]Referral form for you to print and return to us is below. REFERRAL FORMAlternatively, complete your details on our online referral form and it will be emailed directly to us. If you would like to complete the form online, please complete the form fields, these will populate into the correct...","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v15.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Referral Form - Allison Family Mediation Service<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Referral Form - Allison Family Mediation Service\" \/>\n<meta property=\"og:url\" content=\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005\" \/>\n<meta property=\"og:site_name\" content=\"Allison Family Mediation Service\" \/>\n<meta property=\"article:modified_time\" content=\"2021-06-02T09:58:38+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Estimated reading time\">\n\t<meta name=\"twitter:data1\" content=\"3 minutes\">\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebSite\",\"@id\":\"https:\/\/familymediationbarnsley.co.uk\/#website\",\"url\":\"https:\/\/familymediationbarnsley.co.uk\/\",\"name\":\"Allison Family Mediation Service\",\"description\":\"Family Mediation in Leeds &amp; Wakefield\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":\"https:\/\/familymediationbarnsley.co.uk\/?s={search_term_string}\",\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-GB\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005#webpage\",\"url\":\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005\",\"name\":\"Referral Form - Allison Family Mediation Service\",\"isPartOf\":{\"@id\":\"https:\/\/familymediationbarnsley.co.uk\/#website\"},\"datePublished\":\"2020-11-11T12:38:30+00:00\",\"dateModified\":\"2021-06-02T09:58:38+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"item\":{\"@type\":\"WebPage\",\"@id\":\"https:\/\/familymediationbarnsley.co.uk\/\",\"url\":\"https:\/\/familymediationbarnsley.co.uk\/\",\"name\":\"Home\"}},{\"@type\":\"ListItem\",\"position\":2,\"item\":{\"@type\":\"WebPage\",\"@id\":\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005\",\"url\":\"https:\/\/familymediationbarnsley.co.uk\/?page_id=4005\",\"name\":\"Referral Form\"}}]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","_links":{"self":[{"href":"https:\/\/familymediationbarnsley.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/4005"}],"collection":[{"href":"https:\/\/familymediationbarnsley.co.uk\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/familymediationbarnsley.co.uk\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/familymediationbarnsley.co.uk\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymediationbarnsley.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4005"}],"version-history":[{"count":14,"href":"https:\/\/familymediationbarnsley.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/4005\/revisions"}],"predecessor-version":[{"id":4381,"href":"https:\/\/familymediationbarnsley.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/4005\/revisions\/4381"}],"wp:attachment":[{"href":"https:\/\/familymediationbarnsley.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4005"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}