Steps2Wellbeing - Self referral form

If you provide an email address we will send a confirmation email. We may also contact you via email, so please only fill in the "email" box if you are happy to be contacted.

Gender *
If OTHER is selected above please state GP Practice below.
If you would like us to contact you via email, please provide an email address below.
I agree to a message being left by
I agree to a message being left by
Are you completing this form on behalf of someone else? (We can only accept referrals where the patient is aware) *
After clicking on "Submit" you will be redirected to the Steps2Wellbeing website.
Steps2Wellbeing - Improving Access to Psychological Therapies (IAPT)