Self Referral Form

If you feel that your mood is deteriorating, please contact your own GP. The NHS 111 service is also available out of hours on 111.
If you require urgent help for your mental health please call the Mental Health Crisis Line, available 24 hours a day, 7 days a week by calling 0800 953 0110.
If you are seeking help for a problem such as psychosis, bipolar disorder or a personality disorder First Step South Cumbria are unable to offer the appropriate treatments, please speak with your GP about the treatment options available.
First Step South Cumbria sees adults (18+) who are registered with GP Practices in Furness and South Lakes only. If you are registered with a practice outside these areas please contact your GP or NHS (www.nhs.uk) for details of similar services in your area.
If you are in North Cumbria (i.e. Carlisle, Eden, Allerdale and Copeland) please contact First Step at https://www.cntw.nhs.uk/services/first-step/

Personal Details

Communication Details

Should we need to contact you by phone this would be within working hours (this will show up as a withheld number), please let us know which number is best to reach you on during the day. If this method of communication is not suitable please let us know.

GP Details

First Step sees Adults who are registered with GP Practices in South Cumbria only, if you are registered with a practice outside South Cumbria please contact you GP or NHS Choices (www.nhs.uk) for details of similar services in your area.

Further Information

If you feel that your mood is deteriorating, please contact your own GP. The Cumbria Health On Call team (CHOC) are also available out of hours on 111. The Samaritans are available 24 hours a day on 116 123
I consent to you contacting the relevant GP or other services for further information if required in line with NHS Confidentiality agreements. I am aware information will be stored on a database.
Once the form has been submitted online please allow 3 working days then ring 0300 555 0345 during normal working hours to book a telephone assessment appointment. Failure to contact the service within 7 days of day of submission will result in this questionnaire becoming invalid.
Please note that referrals are usually reviewed by a clinician within two working days (Monday-Friday)