Professionals Referral Form

Milton Keynes Talking Therapies is a primary care service for mild to moderate anxiety and depression.
We cannot treat issues directly relating to:
• Psychosis
• Personality Disorder
• Anger
• Conditions in the presence of an un-managed substance misuse disorder
• Bipolar affective disorder
• Organic or functional neurological disorders
• Anxiety/depression of a complexity such that treatment of longer duration is considered necessary to achieve positive outcome.

Referral Source

Patients Details

GP Details

Presenting Problem

Additional Information