Let’s Talk IAPT Referral Form Improving Access to Psychological Therapies Service (IAPT) is a confidential NHS service providing easy access to psychological therapies for people experiencing depression and anxiety. To make a referral online, visit www.lets-talk-iapt.nhs.uk/refer. Please ensure that you complete all of the fields
Name:
Date of Birth:
Gender: M / F
Address:
Postcode:
GP Name:
GP Address:
Date of referral:
Please note that your GP and Health Visitor
(if applicable) will be kept informed of your referral.
What is the main problem that you would like help with, and how is it affecting your life?
How did you hear about us?
GP
Other Healthcare Professional
Search Engine (e.g. Google, Bing)
Leaflet
Workshop run by IAPT
Social media (e.g. Twitter, Facebook)
Family/Friend
Other Please specify……………………………
Once completed please return form to:
Send by post to: West Haringey IAPT 45 Middle Lane, Crouch End, N8 8PH
Send by email to: lets-talk-haringey-west@nhs.net Fax: 020 3074 2301 Telephone number: 020 3074 2280
Website:www.lets-talk-iapt.nhs.uk
Send by post to: East Haringey IAPT 1a Lansdowne Road, Tottenham, N17 0LL
Send by email to: lets-talk-haringey-east@nhs.net Fax: 020 8885 6533 Telephone number: 020 8808 5833
Website: www.lets-talk-iapt.nhs.uk
*If you are worried about acting on suicidal thoughts OR about hearing voices or other psychotic symptoms- Contact your GP or specialist mental health services via The Crisis Resolution and
H
Please turn over
ome Treatment Team on 020 8702 6700 or go to your A & E.
Please see the list below to find the correct team for your GP practice.
Send by post to: West Haringey IAPT 45 Middle Lane, Crouch End, N8 8PH
Send by email to:lets-talk-haringey-west@nhs.net Fax: 020 3074 2301 Telephone number: 020 3074 2280
Website:www.lets-talk-iapt.nhs.uk
Send by post to: East Haringey IAPT 1a Lansdowne Road, Tottenham, N17 0LL
Send by email to: lets-talk-haringey-east@nhs.net Fax: 020 8885 6533 Telephone number: 020 8808 5833
Website: www.lets-talk-iapt.nhs.uk
*If you are worried about acting on suicidal thoughts OR about hearing voices or other psychotic symptoms- Contact your GP or specialist mental health services via The Crisis Resolution and
Home Treatment Team on 020 8702 6700 or go to your A & E.