Trafford Psychological Therapies Service Referral Form

This service provides evidence based psychological therapies for Common Mental Health Disorders. Please only refer people with: Anxiety Disorders (including OCD & PTSD), Depression, or problems related to Stress and Adjustment; who are willing and able to use a talking therapy.

Patient Details

Note: Questions marked by * are mandatory





  Yes No
Does the patient consent to this referral?
Has your patient ever been referred to or accessed psychological or talking therapies:
Has your patient ever been referred to or accessed Secondary Mental Health Services:
s your patient currently prescribed any medications for mental health problems:





*Spam Guard: Is water wet or dry?

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