Parental Capacity Assessment

Referral Submitted

Thank you — your Parental Capacity Assessment referral has been received by the HAPii team.
We will be in touch within 2 working days to discuss the commission, scope, and next steps.

Referral Details

Date of Referral *

Preferred Contact Method *

Referring Person / Organisation

Name *

Position / Role *

Organisation / Agency *

Contact Phone *

Contact Email *

Details of Parent(s) to be Assessed

Name(s) *

Relationship to Child(ren) *

Child(ren) Involved

Name(s) & Age(s) *

Brief Background & Reason for Referral

Current Concerns, Previous Assessments & Questions to Address *

Specific Issues / Questions to Address

Preferred Consultant

Dr Lisa O'Reilly Founder & Director · Guardian ad Litem · Play Therapist · Attachment Researcher Dr Caroline Duignan Guardian ad Litem · Child & Youth Researcher · National Trainer Charlotte Lyne Child & Adolescent Psychotherapist · Play Therapist · Clinical Supervisor Dr Katie O'Donoghue Art Psychotherapist · Chartered Psychologist (BPS) Mel Shanley Guardian ad Litem · Medical Social Worker · Trauma Specialist Kevin Hutton Guardian ad Litem · Residential & Child Protection Specialist Steven Peet Guardian ad Litem · Complex Case Reviewer · Foster Carer No preference Please recommend the best match for this case

Additional Information

Court / Legal Proceedings Involved? *

Immediate Risk / Safety Concerns? *

Next Hearing Date (if applicable)

If safety concerns, please describe

Documents Attached

Care Plan Previous Assessments Court Reports Chronology Other

If other, please specify

Declaration

I confirm I have authority to make this referral and that the information provided is accurate to the best of my knowledge.

Signature (Full Name) *

Date *

HAPii Parental Capacity Assessment Form

Referral Submitted