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

Self-referral Form

Our services remain open, but we are changing the way we do things to allow us to respond the current coronavirus outbreak, please click here for the latest service information

Please note that the referrals are processed between 9am and 5pm, and must not be used if you feel in crisis.

This is an NHS service provided in partnership with our local GPs and other health care providers, to ensure a joined up approach to your care. Information is therefore shared with your GP to support continuity of care. Your information will be held securely and confidentially in electronic and paper format in accordance with the principles of the Data Protection Act 2018. To find out how your information is processed and shared please refer to our ‘Fair Processing Notice’ and sharing information page.

All new referrals to our services will automatically be enrolled to use the Patient Portal, providing the patient has a valid mobile number and opted for SMS communication. The Patient Portal collects several clinical measures and questionnaires essential to your treatment and therapy. For more information on the Patient Portal visit our Frequently Asked Questions page.

We accept referrals from clients who are aged 16 years and over and registered with a GP in West Hertfordshire (Herts Valleys CCG). First we would like to know a little bit about you...

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If your GP surgery is not listed, then you may not be covered under our Hertfordshire Service. If this is the case, please check with your GP which service you are covered by.
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If you have multiple long term health conditions, please elaborate in the -ongoing physical health problem- box further down the page
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Are there any issues with alcohol or recreational drugs?
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Thank you for your referral.

Online referrals will be processed Monday to Friday, 9am - 5pm.
You will be contacted by a member of the team once the referral has been processed.
To enquire about your referral telephone SPA (Single Point of Access): 0800 6444 101

If you are in urgent need of help now please call SPA (Single Point of Access): 0800 6444 101
Or NHS 111 and select the option for mental health crisis