The information you give us on the form or over the phone will be treated in strictest confidence. Find out how we keep your information safe.
Do not use the form if you are having a mental health emergency or crisis.
What to expect
In this form we ask you to provide some personal details and how you would like us to contact you.
Once we have your form, a clinician will contact you within 14 days, if not sooner.
- They will talk to you to find out more about the support you need.
- If you both think psychological support can help you, an appointment will be made for you for an initial conversation. This appointment may be in person or online. This should be within 4 weeks.
- They may also tell you about other services that can help you, such as with your physical health, finances, debt management, housing and benefits, as well as the Infected Blood Compensation Scheme – and how to contact them.
The link below will take you to a separate, secure website, where you can complete the form.
Referral form