Health Professional Online Referral Form

This online referral form is only to be used by health professionals, and specifically for referrals to the Herefordshire Healthy Minds therapy team – it is not for referrals to Primary Mental Health Nurses.
All fields need to be completed where indicated *.

Patient Details

GP Details

Referral Source

If consent is not given then we are unable to process the referral without indication of explicit consent from the person being referred.

Referral Details

Patient’s Requirements/Needs

Other Details