Lexxic Referral — Crystal Pathways

● Online delivery Lexxic Partnership

Step 1 of 4 25%

Step 1 of 4

Referring clinician

Your details so we can acknowledge this referral and contact you if needed

ℹ All assessments under this pathway are delivered entirely online via secure video consultation. If triage indicates a case requires a different approach, we will contact you before proceeding.

Your details

Full name *

Job title *

Organisation

Email address *

Fields marked * are required

Step 2 of 4

Individual being referred

Personal details and contact preferences for the person you are referring

Personal details

First name *

Last name *

Date of birth *

Preferred contact method

Contact email

Contact phone

Assessment type *

ADHD only Autism only Combined ADHD & Autism Clinical triage to determine

Step 3 of 4

Clinical context

Help the clinical team triage appropriately and confirm the online pathway is suitable

Presenting concerns *

Include any workplace, educational or daily-living impact that will help us understand the referral context.

Prior history

Individual has prior neurodevelopmental assessment history or a known diagnosis

Please include relevant details below. Where prior history or clinical complexity is indicated, our clinical team will review the referral before proceeding to booking.

Additional clinical context (optional)

Reasonable adjustments or access needs Online assessments can accommodate a wide range of adjustments — note anything that will help us prepare.

Step 4 of 4

Consent & submit

Review and confirm before sending your referral to the Crystal Pathways team

Review your referral

Data & consent

By submitting this referral, you confirm that the individual named above has given informed consent for their information to be shared with Crystal Pathways Ltd for the purposes of neurodevelopmental assessment, that they understand the assessment will be conducted via video consultation, and that you have authority to make this referral on their behalf.

Personal data will be processed in accordance with UK GDPR. Special category health data is collected under Article 9(2)(h) and stored securely within Crystal Pathways' clinical systems.

I confirm that informed consent has been obtained — including consent for online delivery — and I am authorised to submit this referral *

⚠ Please complete all required fields.

✓

Referral received

Your referral has been submitted to the Crystal Pathways clinical team at Brighton Health Clinic.

CP-LEXXIC-0000

The individual will be contacted within 24 hours to begin the online intake process.

Please quote the reference number above in any correspondence.

Crystal Pathways · Brighton Health Clinic

Neurodevelopmental Assessment Referral

Lexxic Partnership · Online delivery pathway

Reference