Online Health Professional Referral Form

This form can be used by health professionals to refer patients who are:
- registered with a Southwark GP or GP at Hand, or
- Health and Social Care professionals (registered with any GP)

Patient Details

GP Details

Demographic Information

Referral Information - Risk

We cannot monitor risk until the client is seen, so please monitor until then. If there is active risk please refer to Southwark Assessment and Liaison Team or ask the service user to attend A&E.

Referral Information - Mental Health

Referrer Details