Self Referral Form

Please note: This service is unlikely to be suitable for you if you are at immediate or imminent risk to yourself or others. Please click here if you require immediate crisis help.

If you want to find out more about how we use your information please see this page to see our terms and conditions: Privacy Policy.

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 mental health services linked to your GP surgery.

If, for any reason, this referral form is being filled out by a third party, please note that the person must have consented to the referral being made and that information included on the form may be shared with the person.

New Referral Form

Enter your personal details

Please fill out your 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 next of kin.

Terms & Consent

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