Here For Each Other staff wellbeing service team referral form

Please use this form to refer a team to the Here For Each Other staff wellbeing service.

If you are here to refer yourself to the staff wellbeing service, please use our self-referral form.
If you are here to refer a team member or colleague to the staff wellbeing service, please use our team member referral form.

If you would like to refer more than one member of staff, please fill in an individual referral form for each person, rather than using the team form.

This online referral form is fully secure and all details below will be stored on our secure and confidential system. By completing this form you agree to these terms and to be contacted via any available method.

Once you submit the form we will be in contact with an appointment offer as soon as possible.

Please monitor your junk/spam email folder so you don't miss anything from us.

In line with Dorset HealthCare and other NHS Trusts, our service operates a Did Not Attend (DNA) Policy. If you fail to attend two consecutive appointments without prior notification, you will be discharged from our service. Where possible, we would appreciate at least 24 hours’ notice of any cancellations of appointments in order for the appointment to be offered to someone else.

If you or any member of the team requires urgent mental health support, please contact the Dorset 24/7 Connection helpline on 0800 652 0190.

Return to the "Here For Each Other" staff wellbeing website.

Please note that we are now closed to new Psychology referrals until further notice, if you already have an open referral your treatment will be continued. Please use this form for PHYSIOTHERAPY REFERRALS ONLY

Your name *

Your phone number *

Your email address *

Your job role *

Which service do you work in? *

Which organisation do you work for? *

Please confirm that the team you want to refer is aware and consents to the referral *

We are sorry, but we cannot continue the referral without the team's consent

Tell us about the team you are referring into the Wellbeing Hub

Team name *

Which service do they work in? *

Which organisation do they work in? *

Approximately how many people are in the team? *

Please give us an outline of why you're referring this team to the Wellbeing Hub *

Thank you for completing the form. Please press 'submit' and send your referral through to us.

Mental health and wellbeing advice