Refer

Please contact us and our team will be happy to assist you.

Required fields are marked with an asterisk (*)

Section 1

The form below can be used to make referrals to Moving Minds. You should receive acknowledgement within twenty four hours. Please do not hesitate to contact us on 0208 795 2333 or info@moving-minds.org if you have any queries.

Assessment
1	Psychological Assessment and Comprehensive Report
2	Psychological Assessment and Concise Report
3	Counselling Assessment and Report
4	Psychiatric Assessment and Report
5	Neuropsychological Assessment and Report
6	Medico-Legal Assessment and Report
7	Occupational Therapy Assessment and Report
8	Vocational Rehabilitation and Job Placement
9	MMPI and Report
10	Physiotherapy Assessment and Report
Phone
11	Immediate Telephone Psychological Needs Assessment and Report
12	Telephone Triage and Report
13	COPE (Coordinated Phone Based Emotional Support) Telephone Management
Treatment
14	Comprehensive Treatment (EMDR or CBT)
15	Standard Treatment (EMDR or CBT)
16	CBT-Based Counselling Treatment
17	Psychiatric Treatment
18	Neuropsychological Treatment
19	Confidence Boosting Driving Lessons
20	Occupational Therapy Treatment
21	Physiotherapy Treatment
22	Chronic Pain Service

Other – please state:

Please indicate if you have enquired about this case before:	Yes		No
If yes, please provide the MM enquiry reference number:	ENQ

Section 2 - Your Details

Company Name: *
Contact Name: *
Address: *
Telephone: *
E-mail: *
Reference: *
Policy Holder:
Role in the case:	Insurer Claimant Solicitor Defendant Solicitor Case Manager Other

Additional parties involved in this case:

Company Name:
Contact Name:
Address:
Telephone:
E-mail:
Reference:
Role in the case:	Insurer Claimant Solicitor Defendant Solicitor Case Manager Other

Party providing funding:

Contact Name:
Address:
Telephone:
E-mail:
Reference:
Role in the case:	Insurer Claimant Solicitor Defendant Solicitor Case Manager Other

Section 3 - Client Details

Name:
Address:
Telephone:
Mobile:
E-mail:
Date of Birth:
Occupation:

Section 4 - Referral Details

Date of incident (if applicable):
Brief description of incident (if applicable):
Details of any psychological symptoms experienced:
Details of any physical injury sustained:
Additional comments (such as reason for referral):

Section 5

Are there any previous reports included in this referral?

	Psychological		Psychiatric		Medical		Medico-Legal
	Other

Section 6 - Upload

Please upload any relevant documents including reports.

Select a file (5MB Max):

Please be patient if uploading large documents

Why Refer?

We are here to help

If you have a case suggesting psychological issues or treatment we are here to assist by advising the most appropriate course of action.
Our vast clinical expertise, coupled with a commercial outlook, will provide the correct treatment pathway for your client.

We have 10 years experience of dealing with cases for road traffic accidents, accidents at work, clinical negligence, chronic pain, absence management, sexual abuse, major incident management, fraud investigation, medico legal, military and phantom limb pain

Triage and assessment

The most valuable but inexpensive gateway to establishing or confirming a diagnosis.

Triages and assessments will also assist in establishing patient willingness and map out a treatment plan (if treatment is required) with clear, definable goals.

Treatment

Recommended treatment of CBT (Cognitive Behavioural Therapy) or EMDR (Eye Movement Desensitisation and Reprocessing) will commence immediately if instruction submitted with an appropriate and recent report (i.e. less than 6 months before instruction submitted) – we will always ‘reconfirm’ the diagnosis and number of sessions recommended within the initial treatment session to alleviate any therapy drift or overtreatment.

Treatment will always follow NICE guidelines and each and every case is reviewed (clinical governance) to maintain our high standards.