Short Intervention Therapy – Referral form

Referral forms should be sent either using the form below or encrypted, with password protection (with a subsequent password sent in a follow-up email) to: shortinterventiontherapy@northkentmind.co.uk

For data protection reasons, please do not send referral forms that are not secured in one of the above ways.

Referral forms can also be physically handed to reception at:
North Kent Mind, The Almshouses 20 West Hill, Dartford DA1 2EP.

Click here to download the printable form.

Referral form: Short Intervention Therapy

CYP Personal details

Parent/Carer contact details

Emergency contact details (if different to above)

Referral details

Please note, if the CYP is currently engaged in any form of therapy, they will not be able to access this service until that comes to an end.

As part of the SIT service we offer individual and group therapy. Referrals will be assessed internally and assigned services most appropriate for needs.

Please note: CYP with an assigned Early Help Worker will be only offered group intervention.

(including where CYP has Child In Need Status, is on a Child Protection Plan or has experience of domestic abuse/violence)

Referrer details

CYP must remain open to social care throughout the duration of support of the SIT service.