Self referral form | Talking Therapies Bury - SilverCloud eReferral

Talking Therapies Bury - SilverCloud eReferral

Due to the current government guidelines around COVID-19, all Talking Therapies appointments will be carried out by telephone and if appropriate online and video therapy.

At Talking Therapies, we’re offering support through a free online programme called SilverCloud.

SilverCloud has online modules to help improve your mental health and emotional wellbeing, if you’re experiencing low mood, stress or anxiety.

These modules are based on proven methods, such as cognitive behavioural therapy, which aim to help you learn how to think and feel better.

As you work through the online modules, they will be reviewed by one of our therapists - who will give you regular feedback and support.

All information entered is anonymous, confidential and secure. You can access your online account any time, from any device, for up to a year.

Please fill in this form to get started:

* Indicates a required field

NHS Number

Title *

First Name *

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Last Name *

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Date of Birth *

If you are happy for us to communicate by e mail please enter your e mail address *

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Address Line 1 *

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Address Line 2

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Address Line 3

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Town/City *

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Post Code *

Home Phone Number

Voice Mail Home *

Yes

Mobile Phone Number

Voice Mail Mobile *

Yes

We will contact you via SMS text message to provide therapy appointments and reminders. Do you agree for us to contact you in this way?

Yes

Is an interpreter required? *

Yes

Ethnicity *

Please select your gender *

Please select your GP surgery *

First Language *

Reason for referral *

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Please state how you heard about us *

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Have you been living in the UK for the last 12 months?

Are you expecting a child or have a child under 24 months? *

Are you a current or previous member of the military services? *

I accept terms and conditions. *

Contact Telephone: 0161 253 5258