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Referral forms  in EMIS documents February 2023

Adult ADHD

‘Adult ADHD Assessment Service Referral Form’

St Helens integrated Recovery service – Drug/Alcohol Addiction

‘CGL (ADDACTION) Referral form’


‘CYPMHS St Helens Referral Form new Aug 22’

( Emergency or routine referral requests – if Emergency need to contact Response Team – please see form for details)

Community Matron

‘Community Matron referral 2022 amended’

Community Paediatrics – St Helens Developmental Paediatric Service

‘Referral form for Developmental Paediatrics’


Community Physiotherapy

‘Physiotherapy – Community Physio’


Contact Care

‘Integrated Access point Referral form’


Continence Clinic

‘Referral to Adult Continence Service doc’ or ‘Paediatric Continence Referral Form’



‘COPD-St Helens Rapid Response Service’


Diabetes Education – newly diagnosed Type 2

‘BEND2 Referral form’

(this form comes with restrictions -you need to click at top of the form - Review – Restrict Editing and then Stop protection in order to complete form fully)



‘Dietetic Service-Adult & Paediatric April 2018’


District Nurse

‘DN referral form 2020 V2.doc’ - however you can just email district nurses with patient details rather than completing this


Eating Disorders

‘Mental Health Biopsychosocial Referral 2022’


ECG ‘ Urgent or multi-day monitor requests’

‘Direct Access Cardiology – Ambulatory Referral’


Haydock Frailty Team

‘Frailty Referral Form updated Sept 2021’

Gender Identity Referrals

‘GIC-GP-Healthcare-Professionals-Referrals’ (for over 18’s)

For under 18’s the process is changing in Spring 23 so not accepting any referrals until that time


Heart Failure Community Nurses

‘Heart Failure Nurse led Community Nov 2018’


Healthy Legs

‘Healthy legs ref V2.docx’

Healthy Living /Weight Management/ Social Prescribing

(this form also covers – Get Active /Exercise/ Alcohol reduction/Diabetes Prevention/ Healthy Eating/Stop Smoking)

‘Healthy Living Referral Form 2022’

Later Life & Memory Service

‘ LLAMS new referral form – Merseycare’


Long Covid Clinic

‘Long Covid Hub Referral.docx’


Mental Health form - URGENT cases only- routine seen in house. However, discuss potential referrals with Jenny Barret or Karen  Burke

as they liaise with secondary care mental health team

Mental Health Biopsychosocial Referral 2022’



St Helens Neurodevelopmental Pathway Team

(complex form with sections that need completing by GP / Parent/Child & School). However, referrals need to be made by school

‘NDP referral form’


Palliative Care

‘Specialist Palliative Care Referral Form July 21’


Paediatric Occupational Therapy & Physiotherapy

‘Occupational therapy / Physio Children’s Targeted Service’


Podiatry for Adults/children

‘Podiatry Assessment – Referral Aug 2019’


Pulmonary Rehabilitation

‘Pulmonary Rehabilitation June 2018’


Speech & Language Therapy

‘SLT referral form July 21’



‘Direct Access Cardio-Respiratory -Spirometry ‘



‘Rapid TIA Clinic Nov 11’


Wheelchair Service Adults Referral 2022’ or

‘Wheelchair Child Referral Form’











Think Well-being

Think Wellbeing is the primary care psychological therapies service in St Helens. We offer free CBT-based NHS therapy for people aged 16 or above who are experiencing mild to moderate common mental health problems, such as:

Low mood Stress Depression Generalised Anxiety Disorder Phobias Panic Disorder


problems Obsessive Compulsive Disorder Health Anxiety Social Anxiety Post-Traumatic Stress Disorder Body Dysmorphic Disorder

In addition to this, we are also able to offer specific support to service users who are experiencing mental health problems linked to a long-term physical health condition, pregnancy or being a primary carer for an infant under the age of two.

In order to be able to access the service, patients should be registered with a St Helens GP.


Referral Process

Patients can self-refer to us by following this link and completing the referral form:


They can also contact us on 01744 647100

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