Self-Referrals and Enquiries

Please complete the following details if you wish to self-refer or if you have an enquiry regarding one of our mental health services:

Full Name: *

Email: *

Phone Number: *

Can we leave a voicemail? *

GP Surgery *

Which service are you interested in? To make sure that we can understand more precisely what you need, you can only select a maximum of 3 below* *

Wellbeing Services (Dartford, Gravesham & Swanley ONLY)

Please note the services listed above are only available in Dartford, Gravesham and Swanley.

Wellbeing Services (Medway ONLY)

Please note the services listed above are only available in Medway.

Please could you give us some information on why you are coming to us, to make sure we’re giving you the right help. *

NHS Number (this can be found on medical letter, prescription, NHS app or by contacting your GP surgery).

Where did you hear about us?

GDPR *

By ticking this box I agree to North Kent Mind's & LiveWell Kent Partner Privacy Promise (links below to policies).

Thank you for filling out our self-referral form. This will now be sent to a member of our team who will contact you.

Some more information may be needed depending on which service you are interested in.