Self Referral Form

The Staff Wellbeing Hub provides support and talking therapies to staff working in Lincolnshire for the NHS, Lincolnshire County Council, CCGs, St Barnabas and staff working in care and nursing homes
Please note that the Staff Wellbeing Hub for Lincolnshire 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 Hub. 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?