Send only what the receiving professional needs, with the client's consent to share it. Print with your browser's Print command; the site's menus are left off the paper.

Referral letter

Trainee: ____________________ Placement: ____________________ Date: ____________

To and from

Recipient, service, your name and registration number

Client

Name and date of birth (or the identifier the service uses)
Consent to this referral: given on (date)

Reason

What you are asking for, in one sentence

Background

Presenting difficulties, relevant history, assessments and results
Treatment so far and the response

Risk

Current risk, if any, and what is in place

Contact

How to reach you, and when you will follow up

Referring professional: ______________________________ Date: ______________

Template from PsychologyOrbit (https://psychologyorbit.com/templates/referral-letter). Free to print and adapt. No client names, phone numbers, CNIC or hospital numbers, or dates of birth.