Self Referral Form

We are best able to help you if your main issue is low mood, stress or anxiety difficulties. If you are experiencing more chronic and enduring mental health or substance misuse issues you could benefit from seeing your GP before completing a self-referral form to our services to help you choose the most appropriate service for your needs.
If you are in need of immediate help because of a mental health crisis and feel unable to keep either yourself or someone else safe, please call 999.
You can also contact FirstResponse a 24/7 helpline offering immediate advice, support and signposting. 0808 196 3494.

Personal Details

Please complete the following fields. Even if you are already registered with us, it will help us to process your request more efficiently.
Please note – unless you are requesting a place on the Successful Study webinar, we are only able to accept self-referrals from people aged 16 or over. If you live in Suffolk and are aged 15 or under, talk to your GP or health or social care professional who can support you to be referred to our services.
Please note – We are only able to accept self-referrals from people aged 16 or over.
By giving us this information we are assuming that you consent to being contacted in this way.

GP Details

Further Information

To enable us to prioritize your referral please ensure you have provided us with a mobile number with permission to leave voicemail and an e-mail address.