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Step 1

Introduction

Step 2

Eligibility check

Step 3

Your details

Fill in this referral form and a friendly member of our team will get in touch with you within 2 working days, to take some more details and arrange your first appointment.

We are not a crisis service. If you feel at risk of harming yourself, or can't keep yourself safe, please visit our ‘Get urgent help’ page for emergency contacts.

Step 1

Introduction

Who is making this referral?

Referrer details

Are you the patient’s GP?

Step 2

Eligibility check

Check if you are eligible

To access our service, you need to be registered with a GP practice that is local to one of our services.

Visit the NHS website to enter your GP practice postcode and check if it is included in our service areas: Check your GP practice.

Step 3

Your details

Referral form

The minimum age for this service is 17yrs 9 months

Your contact details


We will need to be able to contact you by phone, so please provide us with at least one number. When we call you, it will be from a withheld number within two working days of you submitting the form. If we can’t reach you, we will send you a text or email, or leave you a voicemail to arrange a convenient time. Please ensure you have consented to at least one of these options.

Can we leave a voicemail on this number?

Can we text you on this number?


Can we leave a voicemail on this number?


Can we email you at this address?

When we call you, it will be from a withheld number within two working days of you submitting the form. If we can’t reach you, we will send you a text or email, or leave you a voicemail to arrange a convenient time. Please ensure you have consented to at least one of these options.

By submitting this form, you consent to your information being shared with Insight IAPT. This information will be handled securely, in line with the Data Protection Act 2018. For full details, read our privacy policy.

Referral submitted successfully

Thank you for submitting this form.