Mental health concerns

Have you had any of these symptoms?

Are you worried that people are spying on you or plotting against you?

Are you hearing voices from people you can’t see? They may be saying rude things about you, arguing with you or repeating what you are thinking.

Can you see, smell or feel things that other people say are not there?

Do you feel thoughts are being put into your head or taken out of your head by someone else?

Do you feel your thoughts can be read or heard by other people?

None of the above.

If you have never had these symptoms before of they are getting worse, you need to seek urgent medical help.

Please do not submit this form but instead contact the practice directly or ring 111 out of hours.

If you have had medical treatment for these symptoms before and they are not getting worse, please continue to submit this form.

What symptoms are you experiencing? *

How long have your symptoms been going on? *

What (if any) medical help have you had for your mental health before?

What do you hope to receive from us? *

Please tell us any times in the next 2 working days when you are not available for the practice to contact you. We will try to avoid these times, but please be aware that this may not be possible so do try to be available. *

This service is intended for electronic communication between you and your practice. The information may be read by any member of the practice team and responded to by the most appropriate member of the team. Your practice will endeavour to respond within the timeframe set for this form but will not be able to respond to urgent requests through this service.

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