Self Referral Form

Please note, this form is only to be completed by the person seeking help from Mindsmatter.
We cannot accept referrals from third parties online (including friends and family).
If you are a health professional and you would like to make a referral, please contact the local team (please see for contact details)
Mindsmatter cover the following GP practice areas in Lancashire (Blackburn With Darwen, Chorley South Ribble, East Lancs, Fylde & Wyre, Greater Preston, Morecambe Bay and West Lancs).
If these are not an area that you are registered with please visit : to find your local talking therapies service

Personal Details

Please leave at least one contact number below.
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

The NHS regularly takes part in research on how to improve the experience of patients and the effectiveness of treatment. Please tick yes if you are be willing to allow our researchers to contact you about participating in future research. You can withdraw your consent at any time. If a researcher contacts you will be asked for your consent again before taking part in research.
Mindsmatter is not an urgent service and cannot support people who are in crisis, if you need urgent support please find your local services here
I consent to you contacting the relevant GP or other services for further information if required in line with NHS Confidentiality agreements. I am aware information will be stored on a database.