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Self referrals

Abercorn Clinic is pleased to receive inquiries and direct referrals from prospective new patients. We understand that taking the first step towards seeking support can be significant, and we aim to make the process as straightforward as possible.

 

First steps

To initiate a conversation about your needs and how Abercorn Clinic may be able to assist you, please complete the brief form below. A dedicated member of our clinical team will promptly reach out to you to schedule a convenient time for an initial discussion. This confidential conversation will allow us to understand your current situation better, answer any preliminary questions you may have about our services, and explore the most appropriate way forward for you. We look forward to hearing from you and helping you on your journey.

 

    Client Information

    MrMrsMissMsDrProfRevMaster

    Address & Contact

    Communication Preferences

    MyselfMy emergency contact

    Emergency Contact

    GP Information

    How can we help?

    Is there any history of trauma, safeguarding concerns, or current significant risk (e.g., self-harm, suicide ideation, violence)?

    Financial Awareness

    I am aware of the fee structure for services offered and consent to the Abercorn Clinic Payment Policy.

    Declaration