Steps2Wellbeing - Referral form

Please note that Steps to Wellbeing will NOT accept ONLINE referrals from mental health organisations. If you are a mental health worker (e.g. CMHT), please continue to refer by letter.

Please note that we will NOT accept referrals for under 18s

Referrer Details
Patient Details
Gender *
If OTHER is selected above please state GP Practice below.
Are they pregnant an/or have a child under two years old?
Are they a member of armed forces/family member or Veteran *
Do they have Diabetes? *
Which type?
Do they suffer from chronic pain / Fibromyalgia/ Chronic back pain / MSK? *
Please tick all that apply
Do they suffer from a respiratory condition? *
Please tick all that apply
Does the individual have a cardiac condition / and or has had a thrombosis: *
Please tick all that apply
If you would like us to contact the patient via email, please provide an email address below.
They agree to a message being left by
They agree to a message being left by
Please confirm the patient is aware and consenting of this referral *
This Fair Processing Statement tells you how we use your information. Please read before submitting the form.
After clicking on "Submit" you will be redirected to the Steps2Wellbeing website.
Steps2Wellbeing - Improving Access to Psychological Therapies (IAPT)