Referral Form

Welcome to Let's Talk Wellbeing. We are a Psychological Therapies services for people aged 18+ and registered with a GP within Nottingham City and parts of Nottinghamshire.
Once you have completed the online referral form member of our administration team will contact you by phone within a couple of days to talk through the next steps.
If you are currently feeling suicidal, engage in significant self-harming behaviours or do not feel you can keep yourself safe this service is not the appropriate service for you. Please contact your GP to discuss other options.

Emergency Contact Information

If your mood deteriorates and you need urgent help please contact one of the following:
- GP ‘out of hours' service, 111 who can put you through to an out of hours doctor or help if necessary.
- Samaritans: Telephone support, Tel. 116 123 Hours: 24 hours, 7 days a week Samaritans website: www.samaritans.org or
- In an extreme emergency call 999 for an ambulance or go to the nearest Emergency Department.
- Your GP in surgery hours;
- Wellness in Mind www.wellnessinmind.org. Telephone Helpline 08005610073.

Patient Details

Please note you can only refer to this service if your GP practice is in the area.

Contact Information and Consent

We will use your email to communicate important information about our service, such as appointment times and questionnaires to be completed prior to your appointments. We do not use your email address for any other purpose and never sell your information to any third party. Visit our website for more information: https://www.nottinghamshirehealthcare.nhs.uk/psychological-therapy-contract

Patient Demographics

Reason for Referral

Further Information