Haringey Talking Therapies Referral Form

Please note that unless you work for the NHS or in social care, we can only accept referrals from people aged 16 or over, living in Haringey or registered with a Haringey GP surgery.
We are unable to accept referrals if you have a primary alcohol or drug misuse problem, or if you are already being seen by other secondary care or specialist mental health services.
We are also unable to offer immediate crisis support.
Everything you tell us is kept confidential, however if you disclose information concerning current or potential harm or risk to yourself or another person, we will need to inform the relevant agencies/health professionals to ensure that the right support is provided.
We are required to share information with your GP and/or referrer about your referral and treatment, which we may do either verbally or in writing.
All NHS Talking Therapies services are required to routinely share data with NHS England to achieve better care and outcomes. The data is sent securely and used to produce national anonymous reports. Patients can opt-out of sharing their personal information here https://www.nhs.uk/your-nhs-data-matters/

Referrer Details

If you are a health professional making a referral on behalf of someone else, please complete your details below.

Your Details

If this is a self-referral, please enter YOUR details here. If you are referring on behalf of someone else, please enter their details below:
If you do not have a mobile number, please call 0203 074 2280 and our admin team will take your referral.
We will send a text message with a link to book your first appointment online and for future appointment reminders. If you do not want to receive texts, you will be contacted by letter.
Questionnaires are sent before your appointment via email. If you do not have an email address or prefer to not receive emails, please indicate below.

Please note that your GP and Health Visitor (if applicable) will be kept informed of your referral.

If you are worried about acting on suicidal thoughts OR about hearing voices or other psychotic symptoms. Please contact your GP or specialist mental health services via The Crisis Resolution and Home Treatment Team on 020 8702 6700, or go to your local Accident & Emergency (A&E).