Online Referral Behalf of Veteran

Before completing this referral on behalf of someone else, please confirm that they are:
- A veteran (regular, reserve or national service) of the UK Armed Forces
- Registered with a GP in Wales (if moving to Wales, you will be required to register with a GP in Wales at the earliest opportunity)
- Have a military service-related or suspected military service-related mental health condition.

Referrer Details

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Veterans Details

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Military Service Details

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

If yes, please list location/s and date/s

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Next of Kin Details

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

GP Details

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Reason for Referral

Invalid Input

Risk Issues – Self/Others:

Invalid Input

Invalid Input

Invalid Input

Please be aware that Veterans’ NHS Wales is unable to respond to veterans who need urgent or emergency mental health care. Individuals in crisis or requiring urgent assistance should seek help from their GP or out of hours service. Alternatively, C.A.L.L. is a 24/7 mental health helpline for Wales and it offers a confidential listening and support service. Phone 0800 132 737 or Text ‘Help’ to 81066.

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input