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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

Patient Contact Details

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

We will need to be able to contact the patient by phone, so please provide us with at least one number. We will call the patient within 2 working days of you submitting the form. If we can't reach them, we'll send them a text or email, or leave a voicemail to arrange a convenient time. Please make sure the patient has consented to at least one of the options below.

Has the patient consented to us leaving a voicemail on this number?

Has the patient consented to us leaving a text on this number?

Has the patient consented to us leaving a voicemail on this number?

Has the patient consented to us emailing at this address?

Reason

Risk

Is the patient a risk to themselves or others ?

The patient has told you that someone else is putting them at risk

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

By submitting this form, you confirm that the patient consents to their 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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