Dr Lucy Watkin’s Team
(New ) Liaison Psychiatry for Older People (65 +)
Referral Form
N.B. IF PATIENT HAS A HERTS GP  REFER TO SMHTOP (See Below.)
Patient’s Name……………………………………… GP………………………………………
D.O.B…………………………..
GP Address……………………………
Patient’s Address……………………………………. ………………………………………….
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Ward…………………Consultant
………………. Ethnic Group…………….…………
Marital Status…………………………
Ward Interpreter Required:- Yes / No
Reason for Referral:
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What specifically do you want from the referral ?
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Referrer (please PRINT)………………………………………. Contact No / Bleep………....
Date of Referral……………………………………….
Fax
 Dr
Watkin’s Sec- 020-8375 -2346 .
Tel X 1147
Liaison Psychiatry Nurse -- x 1567
PATIENTS WITH A HERTFORDSHIRE GP- Must be Referred to THEIR TEAM
Herts –Specialist Mental Health Team.
Consultant Dr. Mukhopadhaya 01992 500838
TEL – 01992 - 705855
FAX - 01992 - 705854