Let S Talk IAPT Referral Form

Let S Talk IAPT Referral Form

Let’s Talk IAPT Referral Form

Improving Access to Psychological Therapies Service(IAPT) is a confidential NHS service providing easy access to psychological therapies for people experiencing depression and anxiety.To make a referral online, visit .

Please ensure that you complete all of the fields

Name: / Date of Birth: / Gender: M / F
Address:
Postcode: / GP Name:
GP Address:
Date of referral: / Please note that your GP and Health Visitor
(if applicable) will be kept informed of your referral.
Preferred Contact Number: ______
Interpreter required? / Yes No
OK to leave voice messages: / Yes No / If yes, in which language? ______
OK to send text messages: / Yes No / Is this is a self-referral? / Yes No
OK to communicate via email: / Yes No / If this is not a self-referral, please provide referrer’s name, address and telephone number if different from the GP details above.
Email: ______
What is the main problem that you would like help with, and how is it affecting your life?
How did you hear about us?
GP / Other Healthcare Professional / Search Engine (e.g. Google, Bing)
Leaflet / Workshop run by IAPT / Social media (e.g. Twitter, Facebook)
Family/Friend / Other Please specify……………………………

Once completed please return form to:

Send by post to:
West Haringey IAPT 45 Middle Lane, Crouch End, N8 8PH
Send by email to:
Fax: 02030742301 Telephone number: 020 3074 2280
Website: / Send by post to:
East Haringey IAPT 1a Lansdowne Road, Tottenham, N17 0LL
Send by email to:
Fax: 020 8885 6533 Telephone number: 020 8808 5833
Website:

*If you are worried about acting on suicidal thoughts OR about hearing voices or other psychotic symptoms- Contact your GP or specialist mental health services via The Crisis Resolution and

Home Treatment Team on 020 87026700 or go to your A & E.

Please see the list below to find the correct team for your GP practice.

West Team: / East team:
The 157 Medical Practice / N4 3PZ / The Bridge House Surgery / N4 1TL
Highgate Group Practice / N6 4QA / Hornsey Park Road / N8 0PH
The Surgery, 625 Green Lanes / N8 0RE / The Old Surgery / N8 0RP
Christchurch Hall Surgery / N8 8AE / The Surgery, 618 Green Lanes / N8 0SD
Crouch Hall Road Surgery / N8 8HJ / Havergal Surgery / N15 3DY
153 Park Road Surgery / N8 8JJ / West Green Road Surgery / N15 3PB
Queenswood Practice / N8 8SU / Lawrence House Surgery / N15 4JR
The Vale Practice / N8 8SU / Tynemouth Road Health Centre / N15 4RH
Allenson House Medical Centre / N8 9TB / Spur Road Surgery / N15 4AA
Rutland House Surgery / N10 1DU / JS Medical Practice / N15 4JR
Dukes Avenue Practice / N10 2PS / Philip Lane Surgery / N15 4AB
Queens Avenue Practice / N10 3BJ / The Laurels Medical Centre / N15 5AZ
Bounds Green Group Practice / N11 2PF / Laurels PMS Practice / N15 5AZ
Myddleton Road Surgery / N22 4NW / Grove Road Surgery / N15 5HJ
Stuart Crescent Health Centre / N22 5NJ / Fernlea Surgery / N15 6JR
High Road Surgery / N22 5JB / St Johns Surgery / N15 6QP
Arcadian Gardens Surgery / N22 5AB / St Paul’s Road Surgery / N17 0NJ
The Surgery, 26 Westbury Avenue / N22 6RS / Park Lane Surgery / N17 0JP
Westbury Medical Centre / N22 6RX / Broadwater Farm Health Centre / N17 6BF
The Alexandra Surgery / N22 7UN / Bruce Grove Medical Centre / N17 6QB
Evergreen House Surgery / N22 8JJ / Castle View Surgery / N17 6XE
Morum House Medical Centre / N22 8HE / Morris House Group Practice / N17 6AA
Charlton House Medical Centre / N17 6SB
Somerset Gardens Family Health Centre / N17 8NW
Tottenham Health Centre / N17 8AH
Dowsett Road Medical Centre / N17 9DL
Send by post to:
West Haringey IAPT 45 Middle Lane, Crouch End, N8 8PH
Send by email to:
Fax: 02030742301 Telephone number: 020 3074 2280
Website: / Send by post to:
East Haringey IAPT 1a Lansdowne Road, Tottenham, N17 0LL
Send by email to:
Fax: 020 8885 6533 Telephone number: 020 8808 5833
Website:

*If you are worried about acting on suicidal thoughts OR about hearing voices or other psychotic symptoms- Contact your GP or specialist mental health services via The Crisis Resolution and

Home Treatment Team on 020 87026700 or go to your A & E.

Top View