Please note, all referrals go via this referral form.
For professionals to make a referral, please go to their website and fill out the alternative downloadable form.
This service is for residents of East London Foundation Trust (Newham, Tower Hamlets, and City & Hackney) or whose GP is in one of the aforementioned Boroughs. For those living in other London Borough’s please see the local website.
We understand that these forms can sometimes feel difficult to fill in. The aim of this form is to enable us to direct you to the most appropriate support for you. Your answers are not ‘final’ and will be discussed in more detail at your initial appointment. You may or may not find that some of the questions do not feel relevant to your personal experience. Answering ‘no’ or ‘not at all’ to some questions does not mean that you will not receive help. We offer a range of services, and answering as honestly as possible will help us to work with you to decide which support is best for you.
Everything you tell us is kept confidential, unless you disclose information concerning current or potential harm or risk to yourself or another person, then we will need to inform the relevant agencies/health professionals to ensure that the right support is provided.
By referring yourself to this service you are agreeing that the service may contact and share relevant information with your GP to facilitate your care. This self-referral form will take approximately 10 minutes to complete. Please provide as much information as possible as this will speed up the process.