Referrals

Make a referral to Buxton Healthcare in minutes. We accept referrals from local authorities, NHS professionals, GPs, support coordinators, families and self-referrals.

Referral Form

Individual Being Referred Details

First Name

Last Name

Role/Organisation

Phone/Mobile

Date of Referral

Providing up to date care plan or DST

Upload care plan or DST

Choose File

Preferred Placement Dates

First Name

Last Name

Date of Birth

Individual Mobile Number

Is the phone monitored/any restrictions?

Individual Being Referred Details

Start Date (if applicable)

End Date (if applicable)

Resource Requirements

Staffing Ratio Required

Ratio details (waking nights/day shift etc)

Allocated Social Worker details

Weekly food and activity budget provided?

Any Further Details

Family Contact

Any concerns regarding family contact?

Does the individual have regular contact with family?

Communication Needs

Is the individual non-verbal?

Does the individual use Makaton?

Is English their first language?

Education Needs

In mainstream College/School?

Other educational needs information details.

Personal Care Needs

Requires personals care?

Medical Needs

Any medical needs?

Taking medication?

Any allergies?

Mental Health History

History of self-harm, ideation or diagnosis?

CAMHS involvement? (past or present)

Criminal or Police Involvement

Is the individual subject to any Deprivation of Liberty safeguards or court-ordered restrictions Criminal or Police involvement?

Involvement with Youth Offending Services

Risk of Missing Episodes - Child sexual Exploitation (CSE)/Child Criminal Explotation (CCE)

Known riak of CSE/CCE?

At risk of going missing?

Substance Abuse

Concerns around substance abuse?

Transport Needs/Restrictions

Specific transportation needs/travel needs?

Emergency Contact Details

Emergency contact details for the individual and/or social worker

Any Other Information

Name and Address of current placement

Reason for referral/reason current placement is ending.

Consent Confirmation (if applicable)

Has the individual consented to the referral?

Consent to share this information?

Recreational Needs

Allowed periods of free time?

Cultural/Religious Needs

Any cultural/religious needs?

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Testimonials from Our Team

Since joining Buxton Healthcare LTD, I’ve witnessed firsthand the difference we make. It’s rewarding to see the positive changes in our clients’ lives, and the company’s support has been pivotal in my personal and professional development.

Alice M, Nurse

Referrals

Testimonials

Testimonials from Our Team

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