Refer Yourself

Please read our referral criteria before completing this form which can be found on the How To Get Help section of this website.
Ealing IAPT is not an emergency service and this referral form should not be used if you require urgent support. If you are worried about immediate risk of harm to self or others, please speak to your GP. Alternatively, you can also contact the following services 24 hours a day, 7 days a week: NHS Helpline (111) and the Samaritans (116 123).
Any information that you share with the Ealing IAPT service will be treated in strict confidence in accordance with the provisions of the DataProtection Act 1998.
We collect demographic information, such as religion and sexual oriention to make sure we are providing an equal service for everyone.
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Your Details

GP Details

Please note that if you have indicated risk to self on the referral form, we will have to share this information with your GP because they are involved in your care.

Further Information

Referral Information

What will happen next

If we think we may be able to help you we will offer you an assessment appointment with one of our team. If we think that you could benefit from a different service we will contact you to let you know. We aim to contact you within 7 working days of submitting the referral form.
If you have questions about how we manage your information, you are welcome to discuss these with any staff member involved in your care.