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Step 1

Introduction

Step 2

Eligibility check

Step 3

Your details

Please complete this referral form, and a member of our team will contact your patient within 2 working days to gather further details and arrange their first appointment

Step 1

Introduction

Referrer details

Are you the patient’s GP?

Continue to the next step

Step 2

Eligibility check

Check if you are eligible

To access our service, your patient must be registered with a GP practice within one of our service areas. Please visit the NHS website to enter their GP practice postcode and check eligibility.

If their GP practice is not listed, please call us to complete the referral.

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Try again

Confirm eligibility and continue

Step 3

Your details

Referral form

Contact details

Is Gender Identity the same as Gender Assigned at Birth? *

We will need to be able to contact you by phone, so please provide us with at least one number. When we call you, it will be from a withheld number within two working days of you submitting the form. If we can’t reach you, we will send you a text or email, or leave you a voicemail to arrange a convenient time. Please ensure you have consented to at least one of these options.

Can we leave a voicemail on this number?

Can we text you on this number?

Can we leave a voicemail on this number?

Can we email you at this address?

Reason

Risk

Is the patient a risk to themselves or others ?

Is the patient at risk from others ?

Is the patient currently or previously involved with another mental health service

When we call you, it will be from a withheld number within two working days of you submitting the form. If we can’t reach you, we will send you a text or email, or leave you a voicemail to arrange a convenient time. Please ensure you have consented to at least one of these options.

By submitting this form, you consent to your information being shared with Everyturn. This information will be handled securely, in line with the Data Protection Act 2018. For full details, read our privacy policy.

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Submit referral form

Referral submitted successfully

Thank you for submitting this form.

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Everyturn Mental Health is the trading name of Everyturn a registered charity (charity number 519332) and a company limited by guarantee registered in England and Wales (company number 02073465) and Everyturn Services Ltd, company registered in England & Wales (company number 4391008).

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