Please ensure you complete all of the information boxes below to enable acceptance of the referral.

Please note, by completing this referral, you confirm that your team will retain clinical responsibility for whomever this individual cares for for 8 weeks and/or the duration of their calls with Check in & Chat.  If you discharge the service user this individual cares for before our calls with them finish, calls may be terminated immediately.

Please be aware that Chatters cannot organise services, hospital appointments and undertake other health and social care activities.  Chatters can only signpost individuals to other services as required.

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Section one: Referral details

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Section two: Individual's details

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