Primary Care Mental Health Specialist Referral

 
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All questions marked with a * are mandatory

GP Details
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Client Details
 
Is the patient happy for a message to be left on their answer phone?: *

Please ensure the contact number is current - if not the referral will be returned. Up to 2 telephone messages will be left, if no contact is made within 2 weeks, the referral will be closed.

Please advise clients that our telephone number will show as 'witheld'.

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Referral Information
Does the client know of and consent to this referral?: *
Has the client given verbal consent to Invicta Health accessing their notes?: *

Risk:

Please describe if the client is currently suffering from or has a history of any of the following:

This information is important to help us consider the appropriate assessment arrangements.

Further information

Please provide further information or attach documents if necessary.

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INVICTA HEALTH

Invicta Health Head Office
Corporate Service
Birchington Medical Centre
Birchington
Kent, CT7 9HQ

Tel: 0800 242 5199 or 01227 470057

Registered address: Camburgh House, 27 New Dover Road, Canterbury, Kent, CT1 3DN