Mind Matters NHS Professionals Referral Form

I confirm that my patient is aware their personal information will be held securely on the Mind Matters system. My patient consents to consents to anonymised data to be sent to the Department of Health as standard. We are unable to process referrals for patients who do not give consent.
Your patient is important to us and we will need to be able to contact them easily, please complete ALL fields including permissions to contact.

Referrer contact information if different to the GP

Registered GP Details (If not the Referrer)

Essential Patient Contact Information

Only complete if permission to contact via Email

Further Details