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CADMHAS: Mental Health Advocacy Service

CADMHAS Advocacy for people with Mental Health Issues

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You are here: Home / Referral Forms / IMCA Referral Form

IMCA Referral Form

IMCA Referral (EN)
Reason for Referral (select ONE option only): *
I confirm that the patient/client lacks capacity to give or withhold consent for the decision indicated because of an impairment or disturbance of the mind or brain affecting the way their mind or brain works (e.g. a disability, condition or trauma, or the effect of drugs and alcohol) and they cannot do one or more of the following: *
Is the client in: *
What is their primary communication method? (tick only one box – the most appropriate) *
Client Group *

This post is also available in: Cymraeg

  • Community Referral Form
  • IMCA Referral Form
  • IMHA Referral Form

Opening Hours:

  • 9.00am – 4.30pm Monday
  • 9.00am – 4.30pm Tuesday
  • 9.00am – 4.30pm Wednesday
  • 9.00am – 4.30pm Thursday
  • 9.00am – 4.30pm Friday

We welcome your enquiries!

You can phone us on 01745 813999. Or use our contact form here

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