Mental Health Review

Mental Health Review

If you have been advised by the surgery to submit a routine mental health review please use this form.

 Please note this form is not for urgent or emergency care. If you have concerns about your mental health please contact the practice or 111 if out of hours. 

 

Suicidality

If you're feeling overwhelmed by thoughts of not wanting to live or you're having urges to attempt suicide, get help now. You may be worried about telling someone, it’s important to open up to someone you trust.

  • If you are at immediate risk of suicide call 999 for help.
  • Contact the practice for support or 111 if out of hours
  • Samaritans 116 123 (24hrs/day)
  • Breathing Space 0800 83 85 87 (Mon–Thurs: 6 pm–2 am, Fri: 6 pm–Mon 6 am)
  • SHOUT: Crisis text line 85258 (24 hours, everyday)
  • For online support and resources visit: Staying Safe From Suicidal Thoughts

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Regarding your medication

    Please select one of the following -
    Do you take any non-prescribed medication?
    Over the last 2 weeks have you been bothered by any of the following problems
    This form collects your name, date of birth, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.
    Do you consent to being contacted by SMS Text/Email for Appointments/Recalls/Results or Information from our clinicians or medical admin team.
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Page last reviewed: 19 December 2025