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Insight Eating Insight Health
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Insight Eating Insight Health
  • Home
  • Meet the team
  • Who we help
  • Services
    • Service Information
    • Services for HCPs
  • Contact
  • Blog
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HCP Referral Form

Are you a healthcare professional looking to refer a client to our services? Please fill out the form below, and we will get in touch as soon as possible.

Concerned about your data? Please see our Privacy Policy
Please acknowledge you have received informed consent for filling out this form on your patient's behalf.(Required)

Your Contact Details

Your Name(Required)
The person completing this form

Many thanks for contacting IEIH. A consultant will be in touch via text to discuss your enquiry. Please provide your preferred telephone number below.

Your Email(Required)

Client Details

Name(Required)
Is the Client over 18?

Insight has age restrictions depending on the services that you need. We see ages 8+ for ARFID and 15+ for other eating disorders.

Address
Email(Required)
Is the client a student living away from home?

Living away from home

Please provide some extra information

Home Address
Address for Place of Study

Insight Eating Insight Health Services (IEIH)

Please click on the tab that most closely relates to why you would like support from IEIH

Our Services: Please select one or more
Are you happy to see someone online?
We try to accommodate everyone's preference for face to face or remote, however, due to availability and location we cannot always do this. If you have specific needs regarding this, please mention this in the box below.
How will the client fund any sessions with IEIH?
If applying for funding, if not successful, is the client willing to self-fund?

This form will be reviewed and responded to within 7 days of completion. The form is secure and will only be read by a senior clinician within the IEIH team.

Please note that we are a service that does not work with individuals who have a high risk to their physical or mental health. We are not able to respond to crises.

If you need more urgent help, we suggest you contact your GP or go to A&E.

For immediate support please check NHS Crisis Services

Consent(Required)
Data will not be shared with advertising agencies or third parties. Data may only be shared with healthcare professionals (HCPs) with your express permission and solely for the purpose of providing treatment services. You can request access, correction, or deletion of your data at any time by contacting us and requesting removal.

Please see Privacy Policy

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