Online Health Professional Referral Form

To refer a patient registered with a Lambeth GP to our service, simply fill in the form below. Even if the patient is already registered with us, it will help us to process the request more efficiently. Please advise the patient that we are an opt-in service and they will need to call us on 020 3228 6747 between 9am - 5pm Monday to Friday to arrange their first assessment appointment.
We will only contact the patient if you have indicated they will have difficulties opting in.
If you are not a GP, or are a GP and wish to discuss a referral first, please email the screening team at to discuss the referral before submitting. This email is for health professionals only and should not be given to members of the public.

Patient Details

GP Details

Demographic Information

Referral Information - Risk

We cannot monitor risk until the client is seen, so please monitor until then. If there is active risk please refer to A&T team or A&E.

Referral Information - Mental Health

Referral Information - Access

Referral Information - Eligibility For Treatment

Referrer Details