Referral: IMCA non-Dols

This form is for health and social care professionals only. If you are looking for a service for yourself or a friend or family member please visit our Find a Service page.

Referral form

If you are a health and social care professional making a referral for Independent Care Act advocacy for someone you work with, please complete this form.

Independent Mental Capacity Act advocacy: non-DoLS

"*" indicates required fields

Step 1 of 8

Company

This field is for validation purposes and should be left unchanged.

In which London borough is the advocacy required?*

This will be the borough where the person currently is located.

Eligibility for IMCA*

Select the primary reason that you are referring for IMCA

Long-term accommodation move (more than 28 days in hospital or 8 weeks in residential accommodation)

Serious medical treatment

Protective Measures regarding Safeguarding

Protective Measures regarding Care Review

Have you verified that the person lacks capacity to make the relevant decisions?*

Lacks capacity for relevant decisions

Selecting this box is required before you can proceed

Is there an appropriate person available to consult?

No appropriate person to consult

Reason for referral if an appropriate person is available*

If there is an appropriate person available to consult, please specify why you believe a referral for advocacy is required.

Referral: IMCA non-Dols

Referral form

Independent Mental Capacity Act advocacy: non-DoLS

About the issue

Supporting documents

About you, the referrer

Decision maker

About the person being referred

Location and contact details

Demographic information

Communication

Additional information