• Getting Started with Verus Minds

  • Thank you for getting in touch with Verus Minds. Please complete this referral form as fully as you can. It helps us understand your difficulties and assess whether our service is the right fit for you.

    Submitting this form does not guarantee an appointment.

    We aim to respond within 2–3 working days.

  • 1. About You

  • Date of Birth*
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  • Verus Minds Psychological Services Ltd  |  Registered in England & Wales | verusminds.co.uk

    For queries about this form contact us at info@verusminds.co.uk  Version 1.0 – 2026.

  • Section 2: What brings you to therapy?

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  • 2. How long have these difficulties been affecting you?*
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  • Verus Minds Psychological Services Ltd  |  Registered in England & Wales | verusminds.co.uk

    For queries about this form contact us at info@verusminds.co.uk  Version 1.0 – 2026.

  • Section 3: Brief Risk & Safety Screening

    These questions help us ensure the service is safe and appropriate. Answering “yes” does not automatically exclude you from support.

  • Important: Verus Minds Psychological Services is not a crisis or emergency service. If you need urgent support, please contact your GP, NHS 111, or emergency services.

  • 8. Over the past month, have you had thoughts about harming yourself or ending your life?*
  • 10. Do you currently feel able to keep yourself safe?*

  • Verus Minds Psychological Services Ltd  |  Registered in England & Wales | verusminds.co.uk

    For queries about this form contact us at info@verusminds.co.uk  Version 1.0 – 2026.

  • Section 4: Motivation & Readiness for CBT

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  • 13. CBT is an active, structured approach that may involve trying strategies between sessions. How ready do you feel to engage with this type of work?*

  • Section 8: Practical Preferences

  • 14. Therapy preference*
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  • Verus Minds Psychological Services Ltd  |  Registered in England & Wales | verusminds.co.uk

    For queries about this form contact us at info@verusminds.co.uk  Version 1.0 – 2026.

  • Section 5: Consent & Next Steps

    Please read each statement carefully before submitting this form.

  • The information I have provided is accurate to the best of my knowledge.


    I understand that submitting this form does not guarantee an appointment. (My referral will be reviewed and I will be contacted within 2–3 working days.)


    I understand that if there is an immediate risk to my life or someone else’s life, Verus Minds may contact my GP or emergency services without my prior consent. (In all other circumstances, we will discuss any third-party contact with you first.)

    I understand that Verus Minds is not a crisis or emergency service and that I will seek urgent help elsewhere if needed.

  • Verus Minds Psychological Services Ltd  |  Registered in England & Wales | verusminds.co.uk

    For queries about this form contact us at info@verusminds.co.uk  Version 1.0 – 2026.

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