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Upon receipt of this form, the Cheshire Advocacy Hub will allocate this referral to an Advocate from Age UK Cheshire or Cheshire Centre for Independent Living.

Has the person consented to this referral?
If no consent has been given, is the person deemed to lack capacity to consent to the referral AND is the referral deemed in their best interests?


Please confirm that the patient qualifies for an IMHA service by ticking at least one of the boxes below:

Detained under the following sections of Mental Health Act: -


Please choose as appropriate