Access Community Mental Health – Wiltshire

If the person you wish to refer to this service, are living in Bath, North East Somerset or Swindon, please click here to go to the Second Step website where you will be able to complete a referral form for these areas.

Please complete this form with as much information as possible and that you have the individual's permission to share with us.

Referring organisation details

Please provide us with your details as the professional making this referral

Date of referral

Name of referrer(Required)

Referrer organisation(Required)

Referrer Phone Number

Referrer Email Address(Required)

Details of the person you wish to refer

Name(Required)

Title First Last

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Landline Phone Number

Has this person given permission for us to leave a voicemail on their landline phone? (please select)

Mobile Phone Number

Has this person given permission for us to leave a voicemail on their mobile phone? (please select)

Has this person given their permission for us to send them SMS (text) messages?

Date of birth(Required)

Gender

Pronouns

What would the person you are referring like support with?(Required)

Please include if they have been given a mental health diagnosis, and whether they agree with this diagnosis.

Please list any other agencies involved in the person's care.(Required)

Please provide names of agencies and workers

Risk information (to self and others)(Required)

Please provide details

Confidentiality and data protection

If you have any questions, please get in touch with the team on:

Email:

Wiltshire Access Community MH Team: accesscommunitymentalhealth@alabare.co.uk

BANES Access Community Mental Health Team: Sshaltd.secondstepbanes@nhs.net

Swindon Access Community Mental Health Team Sshaltd.secondstepswindon@nhs.net

Telephone:

Wiltshire Access Community Mental Health Team: 0300 2225745

BANES Access Community Mental Health Team: 01225 261100

Swindon Access Community Mental Health Team: 01793 685070

This service is open from 8.00am to 6.00pm, Monday-Friday.

Referrals to the service will be responded to within 3 working days.