Professional Referral Form

Health Care Professional eReferral

Please note: this service is not suitable if the person you are referring is at immediate or imminent risk to themselves or others. Please see this page to see how they can access support:

To help us to put them in touch with our team, please complete the form below.

If they want to find out more about how we use their information please see this page to see our terms and conditions:

Designs in Mind is contracted by NHS Shropshire, Telford and Wrekin. To access our service you need to be registered with a Shropshire, Telford and Wrekin GP. If your GP is located in a different area, you can click here to find the contact details of the IAPT service linked to your GP surgery:

Please note, that we require consent from the client to process the referral, if the client has not permitted you to submit this referral, do not submit it.

Professional Referral Form

Client/Patient contact information

Please fill out your clients personal details so we can process your referral.

Health & Disabilities

Please give us information about your health and disabilities.

Next of Kin

Please give us details about your clients next of kin.

Referrer Details

Terms & Consent

For us to process your clients referral, please read and agree to our terms.