Male therapist Open Minds smiling after self referral

 

We need to get some information from you so we can register you with NHS Talking Therapies.

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

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

  • You 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 you’re 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 you
  • If you have a severe mental health problem such as schizophrenia or a personality disorder, NHS Talking Therapies isn’t the right service for you
  • If your main issues are due to alcohol or drug use, NHS Talking Therapies might not be for you. Visit the Navigo Hub for support and signposting
  • NHS Talking Therapies is not a crisis service, so contact the Single Point of Access if you need help urgently.

Okay to carry on? Great.

 

A few details about you

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You 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 you by email also enables your therapist to share important documents with you more freely.

Please enter your email address below if we can contact you by email.

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Please complete this section if we can have the details of someone to contact in case of emergency.


Details about your GP

Your GP must be within North East Lincolnshire. Any referrals outside of this area cannot be accepted by NHS Talking Therapies.

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

Please consider telling us about:

  • A recent example of what you 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 you the most?
  • What impact do they have on your daily life?
  • How would you like things to be different?

A few details about access

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Once your application has been submitted, one of our reception team will be in touch with you shortly to arrange an appointment.

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

If you 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.