PDAP Group Work Referral Form

Please Fill in the form Below

How to complete this referral:

By completing this referral form, you are helping us to make contact with the client as safely and quickly as possible. If you would include as much information as possible – this saves the client from being asked the same questions twice and helps us to understand more about their particular needs and circumstances.

Eligibility criteria for this service:
Please be sure to check that the client meets the following criteria before making the referral:

If you have any questions about our service, eligibility criteria, or how to make a referral, please contact:

Julie: Group Work Co Ordinator on 07710700912 or Chris: Group Work Facilitator on 07719054946

Outreach Offices: 01484 308307

Alternative Form Download

If you do not wish to fill in the form below you can download the form and print it off and send it back to us by post.

Simply hit the button below to download the paper version of our form and fill in as much information as possible and send it back to us.

Download Group Work Form

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1. Information about the person making the referral

Please enter your name and contact details

2. Client contact info

3. Client Support Needs/Vulnerabilities:

4. Reason for Referral