Talk for Change Referral Form

Talk for Change is the single point of access for adult mental health and talking therapy services in Milton Keynes.
This form is for self-referrals only. If you are a healthcare professional please call the service on 01908 725099 to request a referral form.
Talk for Change is not a crisis service and we do not respond to referrals immediately. If you are experiencing a mental health crisis and require urgent support call 01908 725099 and select option 4 to speak with the Urgent Care Team.
If you are in immediate danger then call the emergency services on 999.

Your Details

GP Details

Further Information

Emergency Contact Details

Referral Information

Thank you for completing this referral form. We will be in contact as soon as we can to discuss the next steps.
We take your confidentiality seriously. However, you should be aware that if you report immediate intention to harm yourself or commit a crime it is likely that we would have to inform other agencies. We would always try to contact you first before making such a decision.