CAPE Recovery Center / Psychotherapy Service Referral Form

Please select the service you would like to make a referral to:

This form is sent directly to cape via a secure link (SSL). It is immediately moved to a non-web accessible data store.

Welcome to Cape. We are a community-based, provider of specialist mental health support that is based around the principle of focussing on and maximising a person’s strengths. Our strengths-based way of working enables you to:

  • Have hope about the future and enjoy life more.
  • Be an active participant in your life rather than a passive observer of it.
  • Achieve understanding, self-acceptance and have a sense of purpose and meaning.
  • Take a forward-thinking approach to life by taking control of the decisions that affect you.
  • Actively cope with problems and difficulties rather than ignoring them or adjusting to them.
  • Take proactive steps to promote your wellness.

In order for us to be able to help people in the best way we can, it is important that we work with our clients to identify a number of different strengths-based objectives that they would like to work towards achieving. The first step in helping us do this, is this referral form as it is the earliest opportunity we have to gain valuable insight into the person we will be working for, and what they might want to achieve with our support. Please do take the time to give us as much detailed information as you can about the person whom you are referring to us.

This form is for CAPE's Psychotherapy Service ONLY (including individual and group therapies). Please feel free to contact Sarah Farrell at CAPE to discuss client referrals before submitting.

Referrer

Name and telephone numbers of any professionals involved with the person

G.P.

About the client

Gender

Ethnic Group

Housing

Sexual Orientation

Status

Religion / Belief

About the clients mental health history

Type of therepy being sought

Presenting issue / reason for referral.

Strength-Assesment: Identification of the issues

What, if any, issues are there with….

About the clients lifestyle

About risk to self and others

PLEASE ENSURE THAT YOU HAVE ENCLOSED A RISK ASSESSMENT AND ONE OF THE FOLLOWING REPORTS

  • Psychiatric report
  • Social Worker report
  • Forensic report
  • Probation report
  • Hospital discharge report
  • Care Plan

Risk Assessment

Other Files (multiple uploads allowed)

Other Files (multiple uploads allowed)

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