Doncaster self-referral form – NHS Talking Therapies

The NHS Doncaster Talking Therapies service offers a range of talking therapies for common mental health difficulties, such as anxiety, depression or stress. If you are 18 or over, experiencing symptoms of these and would like help to manage them, please complete the self-referral form below. We will contact you within 7 days to see how we can support you.

Prior to completing a self-referral form, please read the self-referral criteria.

This service is only available to people who are registered with a Doncaster GP. If you live in a different area and are not registered with a Doncaster GP, you can find your local Talking Therapies service on the NHS website.

You can also self-refer by calling us. To speak to someone in the NHS Doncaster Talking Therapies team please call 03000 211 556. Our phone lines are open 9am to 5pm, Monday to Friday, but outside of these times you can leave us a voicemail and we will get back to you.

Please note, we do not provide a crisis response service. If you need urgent support then please call one of the following. These services are available 24 hours a day, 7 days a week:

NHS: 111
The Crisis Team: 0800 804 8999
The Samaritans: 116 123

Personal info

Title:

First name:

Last name:

Date of birth

For example, 15 8 1998

Day:

Month:

Year:

Gender:

Contact Info

Address line 1:

Address line 2:

Town or city:

Postcode:

Email address:

Main telephone number:

Alternative telephone number:

Preferred contact number

Main Telephone NumberAlternative Telephone Number

Are you happy for us to leave a voicemail?

YesNo

Would you like to receive SMS text confirmations and reminders for appointments?

YesNo

Are you happy for us to contact you by email?

YesNo

Would you like your appointment?

Other Info

Main language spoken:

Interpreter required?

YesNo

BSL interpreter required?

YesNo

Do you have one of the following long term health conditions?

Do you feel that your mental health difficulties are linked to your long term health condition and would like help with this?

YesNo

GP surgery:

Are you pregnant or do you have children under 2 years old?

YesNo

Are you a veteran?

YesNo

Where did you hear about us?

If 'Other', please give details:

Type of referral

For yourselfFrom a healthcare professional

Healthcare professional information

If healthcare professional supported referral, please confirm that the person being referred is aware and consents to the referral.

First name:

Last name:

Professional role:

Telephone number: