Patient Referral Form

Lewisham NHS Talking Therapies is not a crisis service. If you need urgent support, please do not complete this form. Instead, please:
• Call the SLAM 24-hour mental health helpline on 0800 731 2864
• Call the Samaritans on 116 123
• Call 999 or 111, or take yourself directly to your local Accident & Emergency Department

Please complete all questions below - Your referral may not be processed until all the necessary information has been received.

Your details

Our service only accepts referrals from people over 18 years of age.

Reasons for referral

Service information

How we use your personal details:
• We use your phone number to call and text you about appointment information.
• We use your email address to contact you about your referral, arranging appointments and also to seek feedback on our service.
• We store information on our IT system. This is confidential and cannot be accessed by anyone outside of our service.
• We share anonymous information with NHS England and other statutory bodies that monitor our performance. If you wish to opt out of NHS data sharing please copy and paste the following link to a new web browser
• To find out more about how your information is used – see the SLaM Trust information on Personal Information and Data Protection:
• We work within the bounds of NHS confidentiality and may communicate with other NHS services, within our Trust, as well as other Trusted Health Care Partners in the best interests of your care, this is on strictly needs to know basis. We routinely keep your GP up to date on your care with us, by copying them into correspondence. You have the right to ask with whom your information is going to be shared, and why. You also have the right to request that information is not shared.
• The only time we may need to break this confidentiality is if we are concerned that there is a serious risk of harm to you or someone else.
If you do not understand or agree to the above then please email us on or call 02032281350 to arrange a call back with a clinician to discuss your referral.

After we have received your form...

Your details will be reviewed by a staff member in our team. We will then contact you by email or telephone about progressing your referral.
For all enquiries or to request a call back for further support with completing your referral, please call 0203 228 1350 or email