Professional referral

Form

We’re here to offer a brighter future to those experiencing depression.

If you think your patient could benefit from our service, please complete our short form below and we’ll contact you within 24 hours (Monday to Friday).

Or you can phone us on 0161 716 2144 or email us at pcn-tr.pctmsservice@nhs.net

Referrers details:
Required
Required
Required
Required

Patient details

Required

Reason for referral

Please note:

  • We only offer TMS for depression at this time
  • Please include an overview of your patient’s condition
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Essential criteria check

Unfortunately we’re not able to accept the referral. If you’d like to discuss, please contact us on 0161 716 2144

Required
Required

If the patient is actively suicidal and is not an inpatient, unfortunately we’re not able to accept the referral. If you’d like to discuss, please contact us on 0161 716 2144

Required

Unfortunately we’re not able to accept the referral. If you’d like to discuss, please contact us on 0161 716 2144

Required

Unfortunately we’re not able to accept the referral. If you’d like to discuss, please contact us on 0161 716 2144

Required

Unfortunately we’re not able to accept the referral. If you’d like to discuss, please contact us on 0161 716 2144

Required

Unfortunately we’re not able to accept the referral. If you’d like to discuss, please contact us on 0161 716 2144

Required

Please ensure they are aware and consent and tick yes to confirm

Privacy and consent:

Once you click submit, this information will be sent securely to the designated Pennine Care email inbox.

In submitting this referral, you are confirming that the information provided is correct to the best of your knowledge and that the patient has consented to the information being provided to Pennine Care NHS Foundation Trust.