Health In Mind is a service offering support to adults experiencing mild to moderate anxiety or low mood. If you are feeling stressed out or down due to life events such as unemployment, a relationship break-up or financial difficulties (to name but a few) we can provide help and support. If you have particularly severe difficulties, or if your difficulties have been going on form some time, you should visit your GP so he or she can ensure you get the help you need.
In order to process your self-referral to Health In Mind, we need to gather some important information about you, your difficulties and how you are currently feeling. Please answer all the question below.
They will let your GP know that you have referred yourself into the service.
The information you provide will remain confidential, unless they have concerns about your or another person's safety.
If your GP has recently referred you into the service please do not complete this form.
Print the form first then complete clearly in black pen and send to the address/contact details provided at the bottom of the form.
Self Referral Form