Self Referral Form

Patients Details

We do not accept referrals that are under the age of 18. Please visit the Resources section of our website to find information for Under 18s Support.


Contact Details

Please note that Newham Talking Therapies will be calling from a withheld/private number. We will only leave a message if you have given us permission to do so.

Emergency Contact Details

Please share the details of someone we can contact in the event of an emergency. We would only ever contact this individual where we have concerns about yourself in order to help you find the correct immediate support and this is a requirement to be seen within our service.
You must provide a UK number.


Registered GP Details

By referring yourself to this service you are agreeing that the service may contact and share relevant information with your GP to facilitate your care
We work with Xyla Digital Therapies and ERIS (East London NHS Foundation Trust Remote IAPT service) to ensure we can offer assessments/treatments to residents as soon as possible. It could be that your assessment/treatment is delivered by these partners and by referring you are agreeing to your data being shared with them in order to deliver your assessment/treatment. Our partners follow our own data protection and confidentiality policies.