Reason for referral: Please give brief details of your reasons for referring this patient. What will happen next? The patient will be contacted by a Wellbeing Exeter Community Connector and an arrangement will be made to meet with them. The meeting will take the form of a guided conversation through which the connector and individual will jointly determine areas with which the individual would like support. The connector will then implement the support as agreed with the individual and will follow up at regular intervals. Feedback will be given to the GP when the individual decides they no longer want/need support from their connector. Wellbeing Exeter office use only: Date inputted Unique ID to database: Number: Referral Email Database received via: Reference Number: Phone Fax Referral – allocated please to: give details
Reason for referral: Please give brief details of your reasons for referring this patient. What will happen next? The patient will be contacted by a Wellbeing Exeter Community Connector and an arrangement will be made to meet with them. The meeting will take the form of a guided conversation through which the connector and individual will jointly determine areas with which the individual would like support. The connector will then implement the support as agreed with the individual and will follow up at regular intervals. Feedback will be given to the GP when the individual decides they no longer want/need support from their connector. Wellbeing Exeter office use only: Date inputted to database: Unique ID Number: Referral received via: Email Database Reference Number: Phone Fax – please give details Referral allocated to:
Referral-Form-Wellbeing-Exeter-S1.docx