Professional Referral

Please respond to the following questions to the best of your knowledge.

Only the questions marked with * are mandatory but the more information you can provide us, the more effectively we will be able to help you.

After you submit your form, a member of our team will contact you the next working day. 

If you do not hear from us on the next working day after you have submitted your form, please give us a ring on 0203 228 2545. 

Alternatively, if you do not want to submit an online form you can also make a referral by calling us on 0203 228 2545 between 9am and 5pm, Monday to Friday. You will be put straight through to a clinician who will go through the questions that are on the online form with you.

Can you provide the following information about you:
Can you provide the following information about the patient you would like to refer:
If you don’t know your GP’s postcode, the NHS GP finder finder is an easy way to get it.
What is the best telephone number to contact the patient or the family?
Clinical Information
If you are a registered health professional, you can access a free %mBMI calculator on the Marsipan website or with the associated app.

What will happen next?

Once submitted, this online form will be securely sent to our team and screened by a clinician within one working day. We will contact you for if we need more information or make direct contact with the family to offer a date for an assessment in our service. Click Here to view our Terms and Conditions