Spinning World Referral Form

Information about the person you are referring to us
We are not a crisis service. If you need immediate help to keep yourself or others safe please call NHS 111, your GP, or go to your local Accident & Emergency department. If you feel yourself or others are at imminent risk of physical harm please call 999.
All questions marked with a * are required.

Consent to Refer

Before making the referral please make sure you have:
This service keeps the information that you share with us on a dedicated computer system to ensure that it is stored safely and securely. This is only accessed and used by the IAPT team to plan and monitor your treatment. Information from this assessment and your future care is shared with your GP so they are informed about any treatment you are receiving. We may also want to share information with other professionals who need to be involved in your care to ensure that you receive the correct treatment at the right time and we will ask your permission to do this. On occasions we may need to share information with other professionals without your permission if we are concerned about your safety, the safety of another person, or you inform us that you have/or are about to, commit a serious crime. Should this be the case we will discuss this with you first and involve you in the process if possible.

Client Details

Additional Requirements

Client Contact Details

Risk Assessment

GP Details

Reason for Referral

Referrer Details