New user registration

Self referral registration

Please use this form if you are an individual / family self-referral, looking to use our services. 

Important

This form is only for self referrers who have received a letter from EWHMS Single Point of Access. Please continue to complete this self referral form and upload your letter at the bottom.

If you are wanting to make a new referral into NOWs please contact EWMHS Single Point of Access on 0800 9530222. If you are an organisation or GP please contact us for more information.

If you are referring in more than one member of your family, please confirm DOB next to each name in the next box.
If different to parent / guardian
E.g. NELFT / EWHMS Single Point Of Access
Please include age ranges of adults & children
Please include parents / guardian, children aged 4+
I agree to be accountable for each session, to be educated on the wellbeing techniques that will be coached / mentored via N.O.W's Team.

I understand that I will be responsible for making the sessions (or for ensuring a minor taking the child course) on time and if for any circumstances the session cannot be adhered to the time / date booked, I have 48hrs before the date to notify N.O.W's head office by email or phone in order to reschedule the session.

If any session is missed and N.O.W's is NOT notified, the week will be deducted from the overall 6/12 week programme.
Name of the School for Referral
Please include GP Name, Surgery Address And Phone Number
Please upload a copy of your referral letter.

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