Self-refer a young person to Schoen Clinic Newbridge

Complete this private patient pre-screening questionnaire at any time to suit you.

Please complete this questionnaire if you wish to request private treatment at Schoen Clinic Newbridge. This allows us to gather some important initial clinical information upfront.

We treat children and young people (8-18 years) with eating disorders as inpatients (residential) and via our daycare programme where patients attend treatment during the day.

There are 2 important stages to accessing private treatment with us; 1) complete this pre-screening questionnaire and 2) send a recent GP/CAMHS or healthcare professional referral/clinical summary so we have some medical information to hand. Once we have this information, we will share it with our in-house clinical teams and advise how we can best help.

If you/the patient are clinically appropriate and private funding is agreed, our aim is always to start treatment as soon as possible.

We look forward to hearing from you.

Best wishes

Private Enquiries Team
Schoen Clinic Newbridge

Enquirer/patient information

Enquirer full name (including title)

Best contact telephone number

Best contact email address

Patient full name

Date of birth

Relationship to patient:

Pre-screening questionnaire

If yes, what is the diagnosis?

2. If the patient does not have a confirmed diagnosis, what symptoms are being experienced?

3. If there is no diagnosis yet, what stage is the patient at?

4. Please confirm the patient’s age as of today

If yes, please provide contact name and details. We will only contact them with consent to do so:

7. Where is the patient currently?

8. What is the patient’s approximate weight, height and BMI?

Pre-authorisation code

Policy number

Name of insurer

Please give the exact description from your insurer of what they have authorised (i.e. inpatient/daycare assessment with a doctor)

If you are not using health insurance to fund treatment, please visit https://www.schoen-clinic.co.uk/treatment-funding-options to ensure you are fully aware of our self-funding fees.

There is currently no charge for self-funding inpatient or daycare treatment assessments, which is the final stage to accessing private treatment with us.

We ask these questions for clinical reasons but please be assured, we keep all answers securely held on our systems.

If yes, please give basic details

16. Is there any other relevant information you would like us to know?

Data privacy: I have read and understand the Privacy Policy

Thank you for completing our private pre-screening questionnaire, a member of our friendly team will be in touch as soon as possible.

Conditions

Therapies

Self-refer a young person to Schoen Clinic Newbridge

Enquirer/patient information

Pre-screening questionnaire

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