Here For Each Other staff wellbeing service team member referral form

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Please use this form to refer a member of your team or a colleague 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 whole team to the staff 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 the person you have referred with an appointment offer as soon as possible.

Please ask them to monitor their junk/spam email folder so they 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 they require urgent mental health support, please contact the Dorset 24/7 Connection helpline on 0800 652 0190.

Asset 22.pngReturn 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

About your staff member

Does your staff member have any disabilities? *
Please select all that are relevant
Has your staff member ever received treatment or support from mental health services?

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.

Is your staff member experiencing any of these symptoms?

If you staff member is experiencing any of these symptoms, please assist them to contact their GP or call 111 as soon as possible. If they still need physio support after getting advice from their doctor, please contact us at 01202 130130

Your Staff Member's Contact Details

Your staff member job role

About you

Thank you for completing the form. Please press submit to send your referral to the Here For Each Other staff wellbeing service. We will be in contact with your staff member 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