Memory assessment service referral form
The memory assessment service (MAS) provides a single point of access for all patients with suspected dementia. Do not use this form for self-referrals. Self-referrals are only made by calling the service and if you have previously been with the service and been informed that you can contact us again.
The contact number for the service is 0300 303 5342 If you are unsure of whether to refer, please call to discuss with the team.
Referrals which do not include reference to relevant blood tests having been requested/completed may be returned to the referrer.
Before you start, this form requires you to have the following:
- full set of dementia screening bloods within six months
- patient consent
- GP agreement
- basic cognitive screening test such as 6CIT, MMSE OR GPCOG
- ruled out any physical or mental health causes of cognition change.