Make a Referral

Please note that people need to be a Salford resident or registered with a Salford GP to be eligible for the service.
Please note: For Secondary Care referrals, an up to date risk assessment must also be supplied, in addition to the referral form.

The referral will not be processed until the risk assessment is received.

If you are a referrer to the service and require further information please ring 0161 351 6000.

Return

Which programme is your referral for? *

Client Details*

Emergency Contact Details*

GP*

Medical Alert

Reason for Referral

Reason for referral*

Learning Needs

Language Needs

Referrer Details*

Other Services Involved

(e.g. Psychologist, Counsellor, Wellbeing service etc.)

Risk Assessment*

Secondary Care Referrals*
Please note: For Secondary Care referrals, an up to date risk assessment must also be supplied, in addition to this referral form. Please email your risk assessment to info@startinspiringminds.org.uk, we advise that the document is password protected, you can call us with the password.
All Referrals*

Capacity*

Does the client have the capacity to understand and adhere to health and safety rules of the studios as there are a range of tools, materials and equipment in use throughout the building.

Service User Consent to Disclose Information*