Lambeth Self Referral Form

V2
To refer yourself to our service simply fill in the form, let us know when you are available and we will send you an appointment.
We have included some optional extra questions at the end which could make your phone appointment shorter, please fill these out if you want to.
Please be aware that our service is not a crisis service and if you are in a suicidal crisis, please contact your GP for an emergency appointment, call the Samaritans on 116 123 or attend your local A&E.

Personal Details

GP Details

How did you find us?

What is the problem?

If you are looking for a different kind of help, such as with help with housing or debt problems, please look at our resource page on our website.

Extra Information

Booking Your Appointment

The next step is we will call you for a telephone assessment, which will take about 20-30 minutes, to find out more about your difficulties and discuss next steps.
We will text you a time for this phone call. This will usually be within the next week, and assessments are available Monday - Friday, between 9.15 and 4pm.
Please specify below what days and times you are available for this call in the next week (or suggest other days if more convenient) e.g. Tuesday 10-11, Friday 9-3.30pm, or 'Monday' or 'anytime'. Please offer as many times as you can.
(If you would prefer to call us to arrange this, please call us on 0203 228 6747).
We will then text you an appointment time as soon as possible. Please check your phone daily.
Thank you for contacting us. We look forwards to speaking with you. You will next hear from us via text to tell you about your appointment.
IF YOU WOULD LIKE TO GIVE US SOME EXTRA INFORMATION THAT CAN MAKE YOUR TELEPHONE CALL QUICKER, PLEASE DO SO BELOW. THESE ARE ENTIRELY OPTIONAL.

Are you interested in online therapy?

We offer an online programme to offer flexible and easy to access therapy.
Here is a video link for more information. Please copy and paste it into a new web browser to view it. https://vimeo.com/348176560

Please tell us a little more about your main difficulties