Please fill in the form below.
Islington referrals: Please use the Accept Consortium referral form [click here].
Haringey referrals: Please note that our waiting list is currently closed for Haringey clients (clients with a Haringey GP). It will reopen on July 1st, 2017.
Download a referral form
If you prefer, you can download one of the following forms:
Right click to download and save the Word doc, then email completed forms to firstname.lastname@example.org or via secure email to email@example.com. We also accept letters and faxes.