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 the clinical team will retain clinical responsibility for the patient/service user for 8 weeks and/or the duration of their calls with Check in & Chat.  If the patient/service user is discharged before our calls with them (or the carer) 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.

Required
2. Please confirm the patient/service user is currently accessing CNWL services Required

Please note - a CNWL patient or service user is someone who might access CNWL services that help with mental health, substance misuse or learning difficulties.

3. Is the patient/service users aware of the referral to our service and have they given consent for this referral? Required
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8. I confirm our team will retain clinical responsibility for the Patient or Service User for the duration of calls with Check in & Chat (~8 weeks) Required
Required
Required
Required
12. Do you want help with Digital Skills? For example, would you like to learn how to make healthcare appointments online or use video calls (like Zoom) to chat to friends/family or do online shopping? If you do, we can help you.