Self-referral

At present, you can only self-refer to our Social Prescribing Service and Low-level mental health service. For more information about these services, please visit Our Services.

Please complete this form to enable us to support you. By completing this form, you consent to be contacted by a member of our Health and Wellbeing Team. 

We aim to contact you within 5 working days to organise an appointment or direct you towards a more appropriate service.

IMPORTANT: PLEASE CONTACT NHS 111 IF YOU REQUIRE URGENT MEDICAL ATTENTION AND ARE UNSURE WHAT TO DO. IF IT IS A MEDICAL EMERGENCY PLEASE DIAL 999.

 

 

Health and Wellbeing Referral Form

Health and Wellbeing Referral Form

Name
Name
First
Last
What support do you require?