Self Referral Form

The Staff Wellbeing Service provides support and talking therapies to staff working for Lincolnshire Partnership Foundation Trust.
Please note that the Staff Wellbeing Service is for mild to moderate mental health problems and cannot provide an urgent/emergency service, but we can support you to access the right service to support your needs. However if you feel you are at immediate risk of harming yourself, or someone else please contact your GP or call 999 as a matter of urgency. You can also call NHS 111 for advice or the Mental Health Matters Helpline 24 hours a day for emotional support on 0800 001 4331

Personal Details

GP Details

Further Information

Referral Information

Please give brief details of why you wish to access the Staff Wellbeing Service. Can you describe the way that your problem impacts on your life, how long for have been experiencing this problem and any other information you feel we need to know?