Professional Referral Form

By submitting this referral you agree to the following statement:

I have made my client/patient aware that:

• A member of the Total Wellbeing Luton team will attempt contact via the details provided to discuss the referral further. Total Wellbeing Luton store data and share statistical data with the department of health. This information is held securely and is not viewed by anyone outside of Total Wellbeing Luton. Total Wellbeing Luton will share details with other services if it is believed there is a risk to your client/patient or others.
• Patient Consent - My client/patient has agreed to the release of medical details to relevant staff. They understnd that confidentiality is assured and that they are responsible for their own actions at all times. They are undertaking this programme of their own free will.
• Health Professional Consent - In my professional opinon, I know of no reason why the named client/patient is unable to undertake in the programme(s) referred for.

Can you please make your client/patient aware of the following:

• Social Prescription are unable to support clients seeking housing support who already have a housing case worker or bidding number.
• Social prescription gym pass can only be issued once per client and cannot be renewed.
• Talking Therapies are not a crisis service. Total Wellbeing Luton therapists are trained to support people with low mood/depression, anxiety disorders and Long-Term Conditions impacting mental health. Please provide your client/patient crisis support number should they need immediate support.