1. 1) Self referral form 
  2. 2) PHQ9 
  3. 3) GAD7 
  4. 4) Phobia 
  5. 5) WSAS 
  6. 6) IAPTEmployment 
  7. 7) Risk 
  8. Completed

Kirklees Talking Therapies Self Referral Form

Kirklees Talking Therapies Service is a service which aims to help people with common mental health problems, including stress, anxiety, and depression. We do this by recommending suitable therapies best suited to the problems you are experiencing and the goals that you have set for yourself.

If you feel that you need to refer yourself to our service please complete the following form. Your email address is required to complete the eReferral submission and a confirmation email will be sent to you to acknowledge receipt.

Once you have completed your personal details you will be directed to a number of questionnaires that will help us to fully understand and assess the issues that you are currently facing. This will take approximately 10 minutes to complete.

To help us fully understand the problem that you are experiencing please answer all the questions as clearly and fully as you are able to.

If you are having difficulty with any of the questions or would rather speak to someone directly please call 01484 343700(Monday- Friday 8:30am-4:20pm )

Please note that fields marked with a red asterisk are required.

Indicates a required field

*
*
*
Characters remaining :
Characters remaining :
*
Characters remaining :
*
*
*
*
*
*
Characters remaining :
Characters remaining :
Characters remaining :
*
Characters remaining :
*
*
*
*
*
Characters remaining :
*
Characters remaining :
*
*
*
*
*
*
*
*
*
*
*
*
Characters remaining :

We will keep in touch with your GP and or any other relevant health care professional

If you require immediate attention please contact us on the details below

Contact Telephone: 01484 343700

Contact Email: IAPT.Admin@swyt.nhs.uk