Talking Therapies Referral Form

This self-referral form is an easy way for you to access psychological support and advice from Milton Keynes Talking Therapies Service (IAPT). The service is open Monday to Friday 9am until 5pm.
Having thoughts and feelings of hopelessness can be normal when you are feeling depressed. However, we are not able to provide immediate help and support if you are feeling suicidal or in crisis. If you need immediate help please contact your GP, your local Accident and Emergency (A&E) department, or call the emergency services on 999.
If you complete this form and we are concerned for your safety we will complete a referral to Crisis Services. We would usually try to contact you by telephone beforehand.

YOUR DETAILS

GP DETAILS

FURTHER INFORMATION

EMERGENCY CONTACT DETAILS

REFERRAL INFORMATION

By completing and submitting this form you are consenting for your information to be stored on our confidential service database. This information is held securely and is not viewed by anyone outside of Central and North West London NHS Foundation Trust. More information can be found here: https://mktalkingtherapies.nhs.uk/about-us/your-information.