Tel: 01909 479922
Email: info@freedbeeches.org.uk

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Service Access

FREED-Beeches is a fully inclusive service. We understand everyone’s journey is unique, we have walked different paths and have different life struggles.

We are currently only accepting referrals from those registered with a GP within Mid Notts and Bassetlaw and presenting with a mild Eating Disorder/Disordered Eating.

Suitability will be ascertained by a clinical assessment.

Intervention can be offered for carers, family members and supporting others.

(All terms are subject to assessment protocols and suitability)

Our exclusion criteria includes the following:

If an individual’s BMI is below 17.5 we would advise approaching their GP for an alternative service.
Persons who are identified as being a serious risk to self or others
Complex moderate to severe Learning Disabilities
Complex moderate to severe ASD and complex moderate to severe ADHD
Excessive Alcohol/Drug Misuse

N.B If an individual has been under the care of psychiatric services please speak with a member of our team to assess suitability for a referral to our service on 01909 479922.

Referral Process

Self-referrals can be done by completing the referral form at the bottom of this page. GP and other professional referrals can be done by completing the referral form at the bottom of this page or by sending a letter via post or emailing joanne.ormiston@nhs.net

Please use the referral form below.

Service Access

Name *

Email address *

Contact Telephone Number *

Date of Birth *

Full Postal Address including postcode *

GP Name *

GP Address *

Name of Referrer *

Type of referral

Reason for referral, please give details. *

Do you consider this referral to be urgent? *

Yes

No

Height *

Weight *

BMI *

Do you have any medical diagnosis? If Yes please give details below. *

Have you previously been diagnosed with any of the following? *

None

Depression

Anxiety Disorder

Schizophrenia

Bipolar

Personality Disorder

Borderline Personality Disorder

Personality Disorder Traits

Psychosis

Other – please state in other relevant information

Are you currently taking any prescribed medication? if yes please give details *

Self induced vomiting? Y/N if yes please state frequency *

Are you using laxatives? Y/N, if yes please state frequency *

Do you use other purging methods, eg diet pills. Y/N, if yes give details and state frequency *

Do you eat large amounts of food in a short time with a feeling of loss of control. Y/N, if yes please state frequency

Do you eat large amounts of food when you are not hungry? if yes, how many times per day/week?

Are you preoccupied with thoughts of food in between meals? Y/N *

Do you restrict your daily food/calorie intake? *

Do you excessively exercise? Y/N, if yes please state frequency *

Is your weight stable/falling/increasing? If falling, what is the rate of weight loss? *

Captcha

Have you ever been previously diagnosed with an eating disorder? Y/N, if yes, please give details *

Have you ever received psychological intervention in the past for an eating disorder? Y/N, if yes, please give details *

Have you ever been under the care of psychiatric services? Y/N, if yes, please give details *

Are you currently receiving any other interventions? Y/N, if yes, please give details *

Health Information *

Gender Identity *

Sexual Orientation *

Ethnic Origin *

Religious Belief *

Are you currently using any recreational drugs. If yes please give details in other relevant information *

Yes – often

Yes – occasionally

No

Do you drink alcohol? If yes please give details in other relevant information *

Yes – Daily

Yes – often 3 or more times per week

Yes – occasionally

No

Any other information relevant to your referral?

If you are human, leave this field blank.

Home
Meet The Team
- Reception & Administration
- Schools Co-ordinator
Services Offered
- CBT & Psychotherapy
- Dietetics
Service Access
FACTS
Schools
Funding/Fundraising
Group Therapies
Recruitment
Contact

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