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Self-referral Form

Welcome to the Wellbeing Service Self Referral Form. Please complete the form below.

Where to get urgent help for mental health

  • NHS Website: https://www.nhs.uk/nhs-services/mental-health-services/
  • If you need immediate help in a mental health crisis, please call SPA (Single Point of Access): 0800 6444 101 or NHS 111 and select the option for mental health crisis
  • Call 999 or go to A&E now if someone’s life is at risk or you do not feel you can keep yourself or someone else safe

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If your GP surgery is not listed, then you may not be covered under our Hertfordshire Service. If this is the case, please check with your GP which service you are covered by.
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Would it be okay for us to contact you via SMS (Text message) about your appointments?
This will include text messages about potentially booking your first appointment with us online as well as receiving reminder texts prior to each of your appointments with us.
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If you have multiple long term health conditions, please elaborate in the -ongoing physical health problem- box further down the page
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Are there any issues with alcohol or recreational drugs?
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Thank you for your referral.

Online referrals will be processed Monday to Friday, 9am - 5pm. You will be contacted regarding the outcome of your referral.

To enquire about your referral, telephone SPA (Single Point of Access): 0800 6444 101

If you need immediate help in a mental health crisis, please call SPA (Single Point of Access): 0800 6444 101 or NHS 111 and select the option for mental health crisis.