Self Referral Form

Personal Details

Please can you give us as many options to contact you as possible below as this helps when offering appointments.

GP Details

The next step is that you will be contacted to book a telephone appointment. This will be to tell us more about the difficulties you want help with and explore the available options for support. This will include considering support available from other organisations, as well as treatments we offer. This appointment will take about 30 minutes to complete.
We mainly offer these appointments between 9.00am and 4.00pm, Monday to Friday. We will usually be able to offer you an appointment within one week of receiving your referral.
Please tell us more about your availability over the next week below so that we can try to offer you an appointment that suits you. Please be specific and give us as many options as possible e.g. "Monday to Thursday all day", "Wednesday 12.00-5.00pm", "anytime".
You will then either be contacted to provide more information about your availability, or we will text you the details of your appointment. If you would prefer to contact us to arrange this, please call 0208 228 4040.
Please check your phone and emails regularly so that you don't miss this information. Thank you
Are you in crisis? Croydon IAPT does not offer a crisis service. If you feel at risk of hurting yourself or someone else, please contact your GP's out of hours service, the SLAM 24 hour information line on 0800 731 2864, or present to your local A&E at Croydon University Hospital, all of which are there to help.