Mental Health Referral

Before completing this self referral form, please ensure that you fit the following criteria:
a. You are not open to the adult community mental health team (CMHT); if you do then please contact them first.
b. You are not open to the addictions team; if you do then please contact them first.


Mental Health Referral

Are you suffering from stress, anxiety or depression or any other mental health concerns?

If you are under 16 please contact the surgery.

Do you currently have suicidal thoughts or serious thoughts of self harm?

Please contact the surgery or NHS24 on 111 if the surgery is closed

Your Details

Please provide your details and a member of our team will contact you to book a phone review with a Mental Health Practitioner. This will be within the next few working days, however if you feel your condition is more serious please phone the practice on 01290 456001 or NHS111 if we are closed.

Please use format day/month/year e.g. 16/03/1981

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

Local Services. Ready to Help You Maureen Leggat