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Home / Getting help for mental health / Advice and Guidance Session Self-Referral Form / Professional Referral for Advice and Guidance Session

Professional Referral for Advice and Guidance Session 

Please use this form to professionally refer clients to have an Advice & Guidance Session.

For further information or guidance, please call the Information Service directly on 01865 247788 or email at [email protected] 

GDPR legislation – click here to find out how we manage personal data.

Please ensure that consent has been explicitly provided by the client before completing a referral. By submitting the below form you have consented to Oxfordshire Mind holding yours and the clients contact details in line with our privacy policy. If you do not wish for Oxfordshire Mind to store your contact details on their systems, please contact the Information Service.

Advice and Guidance Session – Professional/Internal Referral Form

If you are a Professional or a Team Member from an associated Oxfordshire Mind Service, and wish to refer a client to Oxfordshire Mind’s Wellbeing Services, please submit the following form.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Client Name*
Date of Birth*
Consent to send SMS message*
Consent to leave voicemail*

Screening Questions – Mandatory for all referrals

Are they still seeing them?*
Is this the first time your client has experienced mental health issues?*
When did your client start to experience issues with their Mental Health?*
Does your client have a diagnosis of mental illness?*
Has this illness affected your clients’ relationships with people, employment or their day-to-day activities for longer than 3 months?*

General Details

For Internal Referrals Only

The below section is for referrals being made from associated Oxfordshire Mind services, such as Primary Care and AMHT Wellbeing

For Professional Referrals Only

The below section is for Professionals wishing to refer their patient
Please confirm that the client consents to this referral being made.*
Do we have their consent to contact them?*