Good Morning

Working in partnership with the

There’s no need for anyone to
deal with problems alone

  • Self-referral

  • No body should have to deal with mental health problems alone, which is why we have a self-referral form to help you, or you and your partner, access our service. If you are referring for couples therapy, a referral form will need to be completed by both applicants.

    We are funded by the NHS so there is no cost to you for treatment, however you must be registered with your local GP’s service in order to access our services, aged over 18yrs if you live in Nottinghamshire and over 16yrs if you live in Derbyshire.

    If you require any help completing this form, please do not hesitate to give us a call on one of the numbers stated below.

    • 01332 265 659 – Derby City and surrounding areas
    • 01246 385 752 – Chesterfield
    • 0115 896 3160  – Nottinghamshire

    By submitting a referral form, you consent to us contacting you directly and sharing your information on our systems.

    For further information, please refer to our Privacy Statement. If you wish to withdraw your consent for treatment and/ or contact with Trent PTS, please contact us at: www.trentpts.referrals@nhs.net, or alternatively via one of the numbers listed above.

  • Over the last 2 weeks, how often have you been bothered by any of the following problems?
  • Not at all Several days More than half the days Nearly every day
  • Over the last 2 weeks, how often have you been bothered by any of the following problems?
  • Not at all Several days More than half the days Nearly every day
  • How much would you avoid each of the following situations?
  • Would not avoid Slightly avoid Definitely avoid Markedly avoid Always avoid
  • People's problems sometimes affect their ability to do certain day-to-day tasks in their lives. How much do your problems impair your ability to carry out the following activities?
  • Not at all Slightly Definitely Markedly Severely

    • Contact us for more information at: Derbyshire 01332 265659 Nottinghamshire 0115 896 3160 Wirral 0151 909 3787

    Working in partnership with the