Primary Health self-referral forms

If you would like to refer yourself to one of our services please click on the relevant link below.

General self-referral form

Social Work self-referral form

Paediatric self-referral form

When you have completed the form you can email it to

When a referral is received our friendly staff will call you to discuss your referral and make an appointment.  You may be charged a minimal fee for your visit, dependent on your income.  We do ask that clients notify us if they are unable to keep their appointment as some services do have waiting lists.  Clients who do not attend an appointment or give less than 24 hours notice of cancellation may be charged a fee.