Talking Space Crisis/support

In the event you don't have access to email, please book an appointment via our Birmingham Mind Helpline on 0121262-3555. Alternatively, we offer a drop-in service between 5pm & 10pm. For our Northfield talking space please click on this link: https://airtable.com/appL5FmI5V4VdLdrw/shrofWeH98uUx9vFl

First name

Last name

Date of birth

Address

Postcode

Phone number

Email address

Confirm email address

Are we able to leave a message/voicemail?

Yes

Your GP Address

Postcode

Phone Number

Interpreter required?

Yes

If yes, please state preferred language.

Referring Organisation

Referrer Full Name

Referrer Contact Details

Reason for Referral

Any Relevant Mental Health History (including previous use of mental health services)

Is the person a risk to self or others? Is The Person a Risk To Self or Others?

Is a 2-1 Appointment Required?

Yes

Location

Appointment slot Please choose from the available appointment slots