Self referral form | NHS Stockport Talking Therapies

NHS Stockport Talking Therapies

The NHS Stockport Talking Therapies service is for people over the age of 16 years, who are registered with a GP in the Stockport area.

We offer support and treatment for those who are experiencing symptoms such as difficulty sleeping, low mood / depression, stress, worry or anxiety, feelings of hopelessness or panic attacks.

It can also help those dealing with the effects of a long-term health problem or chronic pain, Post Natal Depression, Obsessive Compulsive Disorder, phobias, or disordered eating.

With help and support, these feelings and symptoms can be managed, guiding you to a successful recovery.

The service is delivered by a range of professionals including therapists and counsellors, who will find a level of treatment that is right for you. This could be a group workshop, an online or telephone based course of self-help treatment, or an individual therapy session.

We also offer specialist treatment such as EMDR (Eye Movement Desensitisation and Reprocessing) and IPT (Interpersonal Therapy).

If you are currently receiving treatment from a specialist mental health service (such as a community mental health team) or are accessing therapy through somebody else, please speak to your care coordinator or therapist about additional support.

Please note all fields marked with * are mandatory.

If we have identified any concerns for your safety or that of others, we have a legal duty to share this with relevant agencies.

Please be aware that our service is unlikely to be suitable for you if you are at immediate or imminent risk to yourself or others. Please see this page to see how you can access support. Crisis numbers Stockport.

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NHS Number

After attending your initial telephone assessment, please select your preferred method to attend your future sessions *

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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Consent for confidential emails

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

Accommodation Type *

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 *

First Language *

Please select your GP surgery *

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? *

Do you have any difficulties with your current employment or require support to find employment? *

Name of Next of kin

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Emergency number for Next of Kin

Child 1

First Name

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Last Name

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Date Of Birth of Child

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Relationship of Child to you

Child 2

First Name

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Last Name

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Date Of Birth of Child

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Relationship of Child to you

Child 3

First Name

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Last Name

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Date Of Birth of Child

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Relationship of Child to you

Child 4

First Name

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Date Of Birth of Child

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Relationship of Child to you

I accept terms and conditions. *

Contact Telephone: 0161 716 5640