To refer yourself to our service fill in the form below, please note we can only accept referrals from people registered with a Telford and Wrekin GP surgery and aged 16 years or over. Once you have completed and submitted the form we will try to contact you within 5 working days, however if you do not hear from us please call 01952 457415

Self Referral Form

What we do with your information

This service keeps the information that you share with us on a dedicated computer system to ensure that it is stored safely and securely. This is only accessed and used by the IAPT team to plan and monitor your treatment. Information from this assessment and your future care is shared with your GP so they are informed about any treatment you are receiving. We may also want to share information with other professionals who need to be involved in your care to ensure that you receive the correct treatment at the right time and we will ask your permission to do this. On occasions we may need to share information with other professionals without your permission if we are concerned about your safety, the safety of another person, or you inform us that you have/or are about to, commit a serious crime. Should this be the case we will discuss this with you first and involve you in the process if possible.