Before you refer, please think about the following questions…

Are you filling this form for yourself?
You cannot fill in this form on behalf of someone else. This form is not, however, the only way to access the service. You can call us or you can be referred via your GP.
Are you over 18?
Our service is for adults aged 18 and over. If you are under the age of 18 you can refer to the e-wellbeing service in West Sussex here.
Is your GP in West Sussex?
You can check if your GP is in West Sussex here. If your GP is not in West Sussex but you would like to refer to us please call us to discuss.
Will you be available for a 45-60 minute assessment in the next six weeks?
If you will be unavailable for assessment within the next six weeks, we would ask you to refer at a time when you are available.

Do you have one of the following long-term health conditions, and if so, is it having an effect on your mental health?

A cardiac (heart) condition
Diabetes - type 1, type 2 or gestational
Irritable bowel syndrome (IBS)
Musculoskeletal (MSK) conditions
Severe or uncontrolled asthma
Long covid - symptoms for 12+ weeks
Chronic obstructive pulmonary (lung) disease (COPD)

If you do have one of these conditions and it's negatively affecting your mental health, refer directly to our long-term health conditions team.

Find out more

young man self-referring

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Self-refer via our online form now. You don't have to let your GP know first.
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Prefer to refer over the phone?
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