Online Referral Form
Please note: What you share with us remains confidential within the service.
The exceptions to this include if you mention any serious risk of harm towards
yourself, towards others e.g. child protection or any serious criminal acts e.g.
crimes police aren't aware of, including terrorism. As we are an NHS service,
we keep details about you as your GP surgery does. These are stored on a secure
patient record system.
Consent to leave messages?
More About You
Current Prescribed Medication
Previous or Current Service Involvement
Reasons for Referral
Next of Kin