Let’s Talk iapt referral Form



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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.

Preferred Contact Number: ____________________________

Interpreter required?

Yes  No 

OK to leave voice messages:

Yes  No 

If yes, in which language? ______________________

OK to send text messages:

Yes  No 

Is this is a self-referral?

Yes  No 

OK to communicate via email:

Yes  No 

If this is not a self-referral, please provide referrer’s name, address and telephone number if different from the GP details above.


Email: ____________________________________________






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.



West Team:

East team:

 

The 157 Medical Practice

N4 3PZ

The Bridge House Surgery

N4 1TL

Highgate Group Practice

N6 4QA

Hornsey Park Road

N8 0PH

The Surgery, 625 Green Lanes

N8 0RE

The Old Surgery

N8 0RP

Christchurch Hall Surgery

N8 8AE

The Surgery, 618 Green Lanes

N8 0SD

Crouch Hall Road Surgery

N8 8HJ

Havergal Surgery

N15 3DY

153 Park Road Surgery

N8 8JJ

West Green Road Surgery

N15 3PB

Queenswood Practice

N8 8SU

Lawrence House Surgery

N15 4JR

The Vale Practice

N8 8SU

Tynemouth Road Health Centre

N15 4RH

Allenson House Medical Centre

N8 9TB

Spur Road Surgery

N15 4AA

Rutland House Surgery

N10 1DU

JS Medical Practice

N15 4JR

Dukes Avenue Practice

N10 2PS

Philip Lane Surgery

N15 4AB

Queens Avenue Practice

N10 3BJ

The Laurels Medical Centre

N15 5AZ

Bounds Green Group Practice

N11 2PF

Laurels PMS Practice

N15 5AZ

Myddleton Road Surgery

N22 4NW

Grove Road Surgery

N15 5HJ

Stuart Crescent Health Centre

N22 5NJ

Fernlea Surgery

N15 6JR

High Road Surgery

N22 5JB

St Johns Surgery

N15 6QP

Arcadian Gardens Surgery

N22 5AB

St Paul’s Road Surgery

N17 0NJ

The Surgery, 26 Westbury Avenue

N22 6RS

Park Lane Surgery

N17 0JP

Westbury Medical Centre

N22 6RX

Broadwater Farm Health Centre

N17 6BF

The Alexandra Surgery

N22 7UN

Bruce Grove Medical Centre

N17 6QB

Evergreen House Surgery

N22 8JJ

Castle View Surgery

N17 6XE

Morum House Medical Centre

N22 8HE

Morris House Group Practice

N17 6AA







Charlton House Medical Centre

N17 6SB







Somerset Gardens Family Health Centre

N17 8NW







Tottenham Health Centre

N17 8AH

 




Dowsett Road Medical Centre

N17 9DL













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.

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