If you would like to self-refer to either our NHS or Private therapies, please complete the form below.  Please visit our FAQ page for questions and answers regarding availability and other information.

Disclaimer:

Due to the high demand for IAPT services, the Clinical Commissioning Groups have implemented a 12 week waiting period for any self re-referrals to our Swale NHS service from the discharge date of your last treatment episode and 6 months to our Canterbury & Coastal NHS service.  This means that when you complete any current treatment with our service you will have to wait 12 weeks before re-referring to our service if you are registered to a GP in Swale and 6 months if you are registered to a GP within the Canterbury & Coastal area.  However, if you feel you cannot wait this long, we will accept a referral from your GP within this time.

Please note we are unable to complete reports or provide any information for benefit appeals or re-assessments.  This includes ESA and PIP payments.  Full information about this can be found on our FAQ page.

Please note all fields are required to complete your registration.

NHS Referral form

What type of referral are you making? *
Please choose one of the following options. If you choose Couples Counselling, please fill in your partner's details in the notes section below.
If you have chosen Couples Counselling, please fill in your partner's full name and contact information here. Please note we cannot process your registration without your partner's contact information and agreement to treatment.
Name *
Name
Gender *
Your Address *
Your Address
Please make sure the address and postcode given is the address registered with your GP surgery
Please let us know the best number we can contact you on. Please bear in mind we are only able to contact you for completion of registration between 9:30am and 4:30pm Monday to Friday.
Can telephone messages be left? *
Will you accept text messages and automatic appointment reminders *
Can we contact you in relation to your treatment? *
Please enter the name of the surgery and not your GP.
How would you describe your nationality? *
How would you describe your ethnicity?
Do you have a disability? *
If you do not have a disability please insert "N/A" in the box below.
Long Term Conditions *
Do you have any of the following Long Term Conditions?
If you ticked "Other Medical Condition", please specify below.
Employment status *
Do you have any military experience? *
If you tick "Yes", further information will be required.
Have you had any thoughts of suicide or self harm within the past two weeks? *
Have you acted on or made plans to act on the thoughts above?
Please select which treatment location you would prefer to attend. *
Please tick all that apply. Please note: choosing more than one location helps us in allocating you to a therapist within a quicker time frame. Whilst we will endeavour to meet your preferences, due to the high demand for this service, it may not always be possible. Please visit our FAQ page for further information.
What time of day would be best for your appointment? *
Tick all that apply. Whilst we will endeavour to meet your preferences, due to the high demand for this service, it may not always be possible. Please visit our FAQ page for further information.
What days of the week would be best for your appointment? *
Whilst we will endeavour to meet your preferences, due to the high demand for this service, it may not always be possible. Please visit our FAQ page for further information.