MAKE A REFERRAL - L&M Consulting Ltd

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Thank you for considering our Injury and Pain Psychology support for your client.

Got a Question?
To talk with Caroline before referral, please fill out the form below or call her on 07356 074391.

To Refer
Please use the form below to tell us how we can help, and any medical history, current treatment, etc., that we need to know before supporting your client.

PLEASE NOTE: You must have gained your client’s explicit consent (or primary care-giver’s for client’s under 18 years) to give us any information about them and for us to contact them directly.

Thank you. We aim to respond to all requests within two working days.

Your Name(Required)

First Last

Relationship to Client being Referred(Required)

Your Telephone Number(Required)

Your Email Address(Required)

Client's Name(Required)

First Last

Your Client's Preferred Contact Details (Only if we are to contact them directly).

Please tell us about the client.(Required)

My Client has given their consent for:(Required)

Me to give you the information provided above.

You to contact them directly.

How would like us to keep in touch with you regarding this client?

I’d like us to work closely together (e.g., regular discussion &/or progress updates).

I would like an update approximately every 4 support sessions / at the end of support.

I do not need any future contact regarding this client.

If you would like us to keep in touch, how?

Telephone