Portal form 1 - Anxiety UK

Incident form

For use when communicating a serious incident to Anxiety UK

Therapist name(Required)

First Last

Therapist email(Required)

Enter Email Confirm Email

Client ID number (eg AB12345)(Required)

Do not include any personal data.

Date of incident(Required)

Incident category(Required)

Client at imminent risk of suicide / serious self-harm

Client suicide / serious self harm attempt made

Terrorism risk, imminent or otherwise

Imminent safeguarding issue

Something else

Please check the client risk flow chart and only submit details that are of a serious nature

Please confirm what action you have taken.(Required)

I have managed in accordance with my own clinical risk and safeguarding processes

I have contacted emergency services / other relevant authority

As a result of this incident(Required)

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