ANNEX 1 The Helen Bamber Foundation Initial Assessment Form Name of clinician: Date: Name of Client: DOB: Country of origin: Interpreter: Telephone number: Current address: Health Services and professionals involved in clients care i.e. GP, Psychiatrist, social worker, psychotherapist, support worker in another organization e.g Poppy, Medialle Trust Kalayaan etc. (Liaise with all those involved to ensure they are aware of our involvement and what support they are providing to avoid duplication). Contact Details of all involved: 1.GP(name and details) 2. Other agency (Name and details) 3. Other agency (Name and details) 118