GP Integrated Mental Health Service (GPimhs) Request Form

GPimhs is not a crisis service and therefore patients have to be aware that there could be a wait for our next appointment. If immediate attention is required, please navigate this website to consult a doctor or contact crisis services.

Further, please see our GP integrated mental health service (GPimhs) leaflet for more advice.

GP Integrated Mental Health Service (GPimhs) Request Form

This form is for over 18's only.

Mental Health Emergency Service

Mental Health Crisis Helpline: 0800 915 4644

SMS texting for people with speech or hearing difficulties: 07717 989 024

Safe Haven:
Oakleaf Enterprise
101 Walnut Tree Close

To be seen by GPimhs the following must be completed:


Patient Details

Please use this date format: DD/MM/YYYY.
Please include postcode.
Any responses we send will go to this email address.
Does the patient require an interpreter?
Does the patient require disabled access?

Contact Permissions

Please select all that apply.
Can we contact you by phone?
Can we contact you by voicemail?
Can we contact you by text?
Can we contact you by email?

Please provide a brief snapshot of your current circumstances so we know how we can help.
(e.g. any risk to self or others, safeguarding concerns, co-morbidity, learning needs, engagement issues?)

Any queries can be sent to the GPimhs administrator at -