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

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’ (www.hpft.nhs.uk/media/2587/fair-processing-factsheet-2018.pdf) and sharing information page (www.hpft.nhs.uk/service-users/your-information/sharing-your-information)

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 (www.hpft-talkingtherapies.nhs.uk/service/faq).

We accept referrals from clients who are aged 17 years and over and registered with a GP in Mid Essex.

First we would like to know a little bit about you...

Indicates a required field

*
*
Characters remaining :
Characters remaining :
*
Characters remaining :
*
*
*
*
*
*
Characters remaining :
Characters remaining :
Characters remaining :
*
Characters remaining :
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Characters remaining :
*
Characters remaining :
*
Characters remaining :
*
Characters remaining :
*
Characters remaining :
Are there any issues with alcohol or recreational drugs?
*
*
*
*
*
*
Characters remaining :
*
*
Characters remaining :
*

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: 01376 308704 or by email: midessex.talkingtherapies@nhs.net

If you need immediate help in a mental health crisis, please dial NHS 111 and select the option for mental health crisis. You will be connected to a contact centre where trained staff will provide appropriate support and advice 24 hours a day.