Staff psychology service referral

Please note this form can only be used by staff with a valid nhs.net email address who are employed by Chelsea and Westminster Hospital NHS Foundation Trust

We offer psychological consultations, brief support for work-related issues and signposting. If you are unsure if our service is the right service for you or the person you are referring, or if you have any problems completing this form, please contact us to discuss this ().

Important: The Staff Psychology Service does not provide support for non work-related issues—please speak to your GP or self-refer via Keeping Well NWL who offer psychological support to NHS staff.

The Staff Psychology Service is not a crisis service and is unable to provide urgent help. If you feel that you need to speak to someone about your mental health urgently please contact your GP surgery or call your local crisis team (via 111). Please call 999 or visit A&E in an emergency.

Please note: We will contact you via your nhs.net email address once a referral form has been submitted—please ensure you check your email regularly for our correspondence.

Referral details
We can only accept referrals relating to staff who work for Chelsea and Westminster Hospital NHS Foundation Trust
Your ethnicity describes your cultural or ancestral heritage, which is inherited from your ancestors, your parents or grandparents. This may be different to your nationality, which is your legal identity, the country where you are a legal citizen. You may have been born in this country, or you may have moved here and became a citizen. Knowing your correct ethnicity is important to us as it helps us provide the best possible care for you as an individual.
This must be your nhs.net email address
GP details
Work details
Only complete this if you chose offsite/other above
Only complete this if you chose other above
Referral type
If you have ticked 'yes' please skip the 'Referrer details' section and go directly to 'Referral reason'
Referrer details
Only complete this if you chose other above
This must be your nhs.net email address
Referral reason
Please provide as much information as possible so we can process your referral efficiently
Additional support
Is any support or treatment currently being sought or accessed elsewhere? (eg by a psychological therapies or mental health service)? Please provide details below, including if you are on any waiting lists.
Contributors
George Vasilopoulos