Get Cipc Referral Form

Completing the Cipc Referral Form online is a crucial process for facilitating access to counselling services. This guide provides clear, step-by-step instructions to help users fill out each section of the form accurately and efficiently.

Follow the steps to complete the Cipc Referral Form online

1. Press the ‘Get Form’ button to acquire the Cipc Referral Form and open it in your preferred editor.
2. In the 'Details of person being referred' section, fill in the name, date of birth, address, gender, telephone number, and mobile number of the individual being referred. Indicate the preferred method of contact by marking the appropriate option for landline or mobile.
3. Enter the medical card number to proceed with the referral; ensure it is a current and valid number.
4. If the person being referred has additional needs, such as requiring wheelchair access or an interpreter, provide those details in the designated area.
5. In the 'Referrer details' section, include the name of the referral agent, primary care team area, address for the referring agent, and contact information including telephone and fax numbers. Don’t forget to sign and include your job title and the date.
6. If the general practitioner (GP) differs from the referring agent, fill in their name, primary care team area, address, and contact details as necessary.
7. Provide a comprehensive medical history, current medication details, and any relevant mental health history concerning the individual being referred.
8. In the 'Reason for referral' section, elucidate on the main symptoms, presenting difficulties, their duration, impact on daily functioning, and any additional challenges faced by the person being referred.
9. Indicate if the individual has been referred to any other agency and specify if another relative or family member has been referred to Cipc. This information is vital for ethical considerations.
10. Conclude by providing any additional relevant information about the referral and confirm the distribution of the Cipc Information Leaflet to the client to enable them to opt in.
11. Finally, save your changes, then download, print, or share the completed form as needed. Ensure to return the form to the Cipc Counselling Coordinator.

Complete your Cipc Referral Form online today to ensure timely access to support services.