SELF REFERRAL FORM

TALKWORKS, Devon’s NHS Talking Therapies Service, offers free and confidential psychological therapy. We are here to help adults, age 18+, living in Devon (outside Plymouth), who may be experiencing a common mental health problem such as stress, anxiety, depression or insomnia. We offer a range of talking therapies and treatment options to help get you back on track and feel more like yourself again.
You can self-refer to our service by filling out the form below. We will then contact you to arrange an initial appointment with one of our NHS clinicians, who will talk to you about the difficulties you would like help with and the treatment that TALKWORKS offers.
Are you in need of urgent mental health support or are you in crisis? TALKWORKS is not a crisis response service, and if you need help urgently please visit the Devon Partnership NHS Trust website and click the “I need help now” button.

Step 1: About You

Step 2: Contact Details

If you do not want us to leave a voicemail and we are unable to speak to you, we will contact you via email instead.
We are required to let your GP (doctor) know that you are coming along to see us. If you do not know the name of your GP, you can leave this blank and just include the surgery name.

Step 3: Your appointment

Step 4: Please tell us a bit more about yourself…

Please could you share the following information about yourself?
If you have answered YES, we will need to contact the Probation Service before we can proceed with booking an appointment for you.
In the event of an emergency, please provide the details of someone who we can contact:

Step 5:

We share information with the Department of Health to ensure that our service is accessible to all and meets national quality standards. This data is transferred and used securely and it is impossible to identify any individual person in the national statistics. If you have concerns about this, or would like to be excluded from this data, please let the clinician know when you meet with them. Your details will be retained on our secure electronic system. If you have any concerns about this please let us know when we contact you.