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SEDS Referral

Important information:

  • All sections are required for your referral to be safely processed and any forms with missing information will be rejected.
  • There may be a considerable wait for assessment. Therefore, the patient remains under your care for any clinical management until they have been assessed by one of our clinicians.

SEDS Referral

Person's Details

Gender: *

Patient given consent for referral?*

Referrer Details

Contact Preferences:

GP Details

Reasons for Referral

Suspected ED:*
Recurring Illness?*
Laxatives? *
Vomiting? *
Binging? *
Exercising? *

Weight History

Weight Fluctuation:*

Risk and Comorbidity

Select all that apply:

Risk of harm to self

If acute refer to ATS & urgent care

Is the patient having suicidal thoughts?*
Do they have a plan?*
Is there a history of suicide attempts?*
Is there a risk of self-harm?*
Is there a history of self-harm?*
Any other risk issues? *

Terms & Conditions

On receipt of the referral we will consider whether or not the eating disorder service may be the most appropriate service. If an appointment is offered this will be prioritised based on the presenting need.

The information you have provided will only be used for the purpose of receiving your referral and contacting you for further information about your referral if required. Your information will not be shared with anyone else without your consent. Information will be held as a part of the service user's record in line with the NHS Records Management Code of Practice.