Arrange a call back with Early Help & Wellbeing Team

This self-referral form is for MEMBERS OF THE PUBLIC MAKING A SELF-REFERRAL ONLY. If you are a professional / organisation wanting to make a referral on behalf of the person, please call our duty line 0333 032 2958 or email MH.Wellbeingteam@essex.gov.uk to discuss/request a referral form.

We are not a crisis service. Is your life at risk? In an emergency call 999 for an Ambulance, or call NHS 111 (Option 2)

Your contact details

Name*

Pronouns*

Phone number*

Alternative phone number

Postcode*

Date of birth*

Give a brief reason for contacting Early Help & Wellbeing Team*

	* Please tick to agree with the terms & conditions
	* Please confirm your consent for this information to be passed to Early Help & Wellbeing Team

Submit

earlyhelp.wellbeingteam@essex.gov.uk

03330 322 958