Here For Each Other staff wellbeing service self-referral form

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

  • If you are here to refer a member of your team or a colleague to the wellbeing service, please use our team member referral form.
  • If you are here to refer a whole team to the wellbeing service, please use our team referral 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 require urgent mental health support, please contact the Dorset 24/7 Connection helpline on 0800 652 0190 or visit our access mental health page for more options.

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

About you

Your contact details

Your job role

Your health history

Are you pregnant, and/or do you have a child or children under 24 months? *
Please tick all that are relevant to you

Is this referral for physiotherapy? If yes, please answer the next question. Select 'Not applicable' if your referral is for other support and continue filling the form

Are you experiencing any of these symptoms?

If you are experiencing any of these symptoms, please contact your GP or call 111 as soon as possible. If you still need physio support after getting advice from your doctor, please contact us at 01202 130130.

Is this a referral to the 3Rs course? (A course for staff on sick leave to help them return to work) *
Thank you for completing the form. Please press 'submit' and send your referral through to us. 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. If you require urgent mental health support, please contact the Dorset 24/7 Connection helpline on 0800 652 0190.
Mental health and wellbeing advice