Female service user smiling in NHS Talking Therapies session after referral

This referral form is to be completed by professionals who are referring someone else into NHS Talking Therapies. If you're looking to refer yourself, please complete the NHS Talking Therapies self-referral form instead.

 

We need to get some information about you and the service user so we can register them with NHS Talking Therapies.

Completing the form below doesn’t automatically mean they have been accepted, but the team will be in touch to discuss the next steps within a week. If the service user is in need of more urgent help, they should contact the Single Point of Access.

First, there are a few things we need to make sure you’re aware of:

  • The service user must be at least 16-years old and registered with a GP in North East Lincolnshire
  • We securely store the information you give us, but if you’re worried you can also read our full privacy policy to put your mind at rest
  • If the individual is already getting support from another mental health team – for example, the community mental health team – NHS Talking Therapies might not be the right service for them
  • If the individual has a severe mental health problem such as schizophrenia or a personality disorder, NHS Talking Therapies isn’t the right service for them
  • If their main issues are due to alcohol or drug use, NHS Talking Therapies might not be for them. Visit the Navigo Hub for support and signposting
  • NHS Talking Therapies is not a crisis service, so contact the Single Point of Access if they need help urgently.

Okay to carry on? Great.

 

About the referrer

 

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About the service user

 

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The service user will be sent a verification email to confirm the referral has been sent and received if you provide us with an email address. We strive to be 100% paper-free and prefer sending appointment letters by email. Giving consent to us contacting the service user by email also enables their therapist to share important documents with them more freely.

Please enter their email address below if we can contact them by email.

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To help us triage this referral, please tell us about the problems that have brought the service user to seek talking therapy at this time.

Please consider telling us about:

  • A recent example of what they have been feeling and why — examples may include relationship breakdowns, loss of a job, poor self-esteem or worry
  • When did the feelings start and how long has this been going on?
  • What part of these feelings affect them the most?
  • What impact do the feelings have on their daily life?
  • How would they like things to be different?

A few details about access

 

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Once this referral has been submitted, one of our reception team will be in touch with the service user to arrange an appointment.

If they are unable to get in contact with them initially, they will continue attempting to contact them for two weeks by the options you have chosen above.

If they do change your mind about wishing to see us, please contact us to let us know.

The information you send will be stored securely but you can read our full privacy policy for peace of mind.

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Please note: we are currently experiencing a potential issue with online form submission on the Navigo website.

If you are struggling to submit this form, please call (01472) 625100.

 

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