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).

HPFT Talking Therapies Service is now offering patients the opportunity to select and book their own appointments via the new appointment booking portal. This online service is available 24 hours a day 7 days a week.
You will receive a SMS Text message invite with a unique link to book your appointment with one of our Talking Therapy clinicians. The link is valid for 7 days.

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 :
*
*
*
Would it be okay for us to contact you via SMS (Text message) about your appointments.
*
*
*
*
*
*
*
*
*
*
*
*
*
Characters remaining :
*
Characters remaining :
*
Characters remaining :
*
Characters remaining :
*
Characters remaining :
Are there any issues with alcohol or recreational drugs?
*
*
*
*
*
*
Characters remaining :
*
*
Characters remaining :
*