Team of Therapists offering Psychology, EMDR & Counselling

Adults, Couples, Children & Families

Malvern, Worcestershire, UK

01684 877 115

NEW ENQUIRIES

contact@malvernhillsprivatepractice.co.uk

contact@malvernhillsprivatepractice.co.uk

Self Referral Form

Welcome to our Self Referral Form. If you would like to see one of our therapists, please let us know by completing the below form. The purpose of this form is twofold:

 

1. Helping you find the most suitable therapist
Finding a suitable therapist can be tricky and we hope to bring clarity to this decision by recommending therapists in our team that will suit you the most (based on your needs and availability). Your form will be personally reviewed by Dr Abigail Pamich, Consultant Clinical Psychologist and her recommendations will be passed on to you. There is no obligation to book with the therapist we suggest, we just want to provide our ideas to help you find the right person. This form is confidential and will be password protected in our system, held under strict GDPR rules.

If you prefer, you are welcome to call the practice and our Psychology Secretary Ruth can go through the form with you over the phone -01684 877 115.

 

2. Providing a foundation for your initial session

If you decide to book with one of our therapists your referral form will provide the foundation for your initial therapy session and guidelines on particular goals and directions for therapy .

We have both face to face and remote therapy sessions available.
Who is the client?

Client Information

Please tell us a little bit about the person who is interested in therapy
How are you wanting to pay for sessions?

Previous Support

It helps guide our decisions to know what therapy has helped/ not helped in the past

How Can We Help You?

Please give us as much detail as you feel comfortable with. The more details you provide the more we can choose the most suitable therapist for your need.
Sometimes people have nightmares, intrusive thoughts and/ or flashbacks of past events, suggesting underlying trauma. This is useful for us to know as EMDR may be helpful.
Sometimes a different therapist to your initial preference, may suit your needs more, or your preferred therapist could be fully booked. When we review your form we may suggest more than one therapist.

Caring For Your Safety

If you feel unsafe - either from yourself or someone else - please call 111 and let them know, or 999 if you are in crisis. Other helpful contacts are: 116 123 (Samaritans), 0800 58 58 58 (Calm) or Text “SHOUT” to 85258 or the Domestic Violence Helpline 0808 2000 247 .
Respecting your confidentiality and privacy is fundamental to our practice. Your form will be stored securely in our password protected system and governed by strict GDPR rules. If you book in with one of our therapists they will read your referral form before your initial session. We will not share your information with anyone outside our practice, unless we believe you are at imminent risk of harm (or a child or vulnerable adult is at a serious risk). In this instance we are legally bound to share basic information in order to keep you (or a vulnerable other) safe.
How did you hear about our service?

Next Steps

Dr Abigail will review your form, answer questions and make recommendations based on which therapists may be most suitable. We aim to provide you with support as quickly and as simply as possible.
Dr Abigail will email you her recommendations. Please allow up to 4 working days. (Please check your junk email in case it lands there). You are then welcome to telephone our office to book your session with your recommended therapist. Alternatively, if you want to go on a waiting list for a particular therapist, then please email us back.