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Get Help
Stories of Recovery
Restore Recovery Groups
Partner Recovery Groups
Coaching
Oxfordshire Recovery College
Information for Carers
Refer Yourself or Someone You Know
What’s on
Latest News
Shops and Cafés
Social Events
Sponsored Events
Volunteer
Volunteer Roles
Volunteer FAQs
Volunteer Application
Corporate Volunteering
Access for Current Volunteers
Fundraise
Make a donation
Participate in a Sponsored Event
Organise a Fundraising Event
Fundraise with your Community Group
Support us through your Company
Leave a Gift in your Will
Training
Mental Health First Aid Training
Working with Mental Health
Oxfordshire Recovery College
Venue Hire
Garden Cafe
Manzil Way Large Training Room
Small Rooms
Elder Stubbs Training Room
Venue Booking Form
DONATE
Refer Yourself or Someone You Know
Client Full Name:
*
What are the recovery goals for the client?
Client Contact Details
If the referral is to a specific service - which one?
Recovery
Employment
Specific location (Please specify below)
Other (Please specify below)
Specified location (if applicable):
Other (if applicable):
Client Address:
Client Post Code:
Client Telephone:
Client Mobile:
Email
Information that we also need
Client Date of Birth:
Client NHS Number:
Name and address of GP:
Name and address of Psychiatrist / Social Worker / CPN:
Main Language:
Care Plan
If the client has a Care Plan (CPA) and/or Risk Assessment we require copies of these
CPA (if applicable)
Risk Assessment (if applicable)
Cluster Number (if applicable)
Referrer
Name of Referrer:
Job title of Referrer:
Address of Referrer:
Telephone of Referrer:
Referring Agency:
Self-referral
Family or Friend
Community Mental Health Team (please specify team name below)
SIL Provider (Please specify organisation name below)
TalkingSpace
Oxfordshire Well Being Service
GP
Other (Please specify organisation name below):
For Self Referrals
Please include with this referral a letter from your GP stating any supporting further information including any risks they feel are relevant. You may also ask your GP to send the above information to us by email to: referral@restore.org.uk or by post to: THE REFERRALS COORDINATOR, RESTORE, MANZIL WAY, OXFORD, OX4 1YH. This must be provided if you are not currently being supported by Mental Health services. If this information is not provided your application will be delayed until we receive it.
If you have requested your GP to send us this information by email/post and you are happy for us to discuss this information with them please tick this box
For GP Referrals
Please include with this referral any diagnosis, medication and supporting further information including any risks you feel are relevant. If this information is not provided the application will be delayed until we receive it.
Referrals from other Mental Health Services
Yes, I have included a copy of current CPA, stating cluster number
No, I haven't included a copy of current CPA, stating cluster number
If this information is not provided the application will be delayed until we receive it.
If answered No in the previous question, please explain why
Only applicable to Referrals from other Mental Health Services
Referrals from other Mental Health Services
Yes, I have included a copy of the applicant's most recent Risk Assessment
No, I haven't included a copy of the applicant's most recent Risk Assessment
If this information is not provided the application will be delayed until we receive it.
If answered No in the previous question, please explain why
Only applicable to Referrals from other Mental Health Services
Community Mental Health Team name (if applicable):
SIL Provider name (if applicable):
Other name (if applicable):
File
File
Do you or does someone you know need help from Restore?
Referral Form