Self Referral Form

V2
Are you registered with a GP Practice in Lancashire, these are the commissioned areas which we cover - Blackburn With Darwen CCG/Chorley South Ribble CCG/East Lancs CCG/ Fylde & Wyre CCG/Greater Preston CCG/Morecambe Bay CCG/St Helen's CCG/West Lancs CCG.
If these are not an area that you are registered with please visit : www.nhs.uk - NHS Choices to find your local talking therapies service.

Personal Details

NB: We will do our best to match the time of day selected, however not all teams have the capacity to offer evening appointments.

GP Details

Further Information