Barnet Wellbeing Hub External Referral Form

Individual’s Details

Have they accessed the Barnet Wellbeing Hub before?
Is an Interpreter Required:

Referrer’s Details

GP Details

Consent to Contact GP

Emergency Contact

Reason For Referral

Emotional Health Check

Has an Emotional Health Check Been Completed:

Outcome of Emotional Health Check:

Thanks for submitting!

For further information and queries please contact us on 03333 44 9088 or email us at info@barnetwellbeing.org.uk