Self Referral Form

After you have submitted your self-referral form, please expect a call from us within 24 hours (excluding weekends) to book in an assessment. Please note, we may call from a mobile number or a withheld number.

Your Details

Your GP Details

Richmond Wellbeing Service sees patients who are registered to a GP practice within the Richmond-upon-Thames borough. If you are registered outside of this, please contact your GP for details of similar services in your area.
By referring yourself to this service you are agreeing that the service may contact and share relevant information with your GP to facilitate your care.
We will never release your information to third parties for marketing.