Self referral

iCope provides a psychological therapy service for people registered with a GP in Kingston. Please complete the form below if you would like to access our service:

If you have a diagnosis of Psychosis/Schizophrenia, Bipolar Affective Disorder or Personality Disorder, or you have had a recent admission to a Psychiatric Unit or A&E, please ask your GP to make a referral to the relevant Mental Health service on your behalf. This ensures you are referred to the relevant Mental Health service for you and will minimise any delay in your treatment.














Main presenting problem(s): please tick as appropriate:








Demographic Questions





Long Term Condition(s): please tick as appropriate:





Thank you for taking the time to fill in this confidential form. Your details will be passed to our team once you press the "Send your details" button below.