Mental Health Form

This form is designed for patients who have mild anxiety and/or depression symptoms to help you consider factors affecting your mental health and inform you about self-care and the management options available.

If you have thoughts of ending your life/self-harm /suicide/harming others please call us for an assessment urgently or you can contact the crisis team out of hours, do not compete this form.

Please use format day/month/year e.g. 12/05/1979
Enter Email
Would you consider CBT or therapy to help your symptoms?
Medications can be considered. Is this something you would like to know more about?
Which Barclay Medical Practice branch are you registered with?

Privacy Policy

This form collects your name, date of birth, email, 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.