Make an enquiry - Frith Psychiatry

Patient consultation

Thank you for your enquiry. Please fill in the form below so we can get in touch with you.

First name:

Last Name:

Age:

Your email address:

Brief description of your mental health difficulties, in your own words:

Goals in seeking help – what do you want help with (if you know)?

Please list any current psychiatric medications or psychological treatments:

Do you have any information or communication needs that need support or adjustment to help you access this service?

What times suit you best for appointments?

Do you have access to the internet and a private space?

Yes

How would you like us to contact you? Please provide details:

Please fill in the below form so we can get in touch with you.

Name:

Last name:

Organisation and job title:

Your email address:

Please outline your enquiry or service request here:

How would you like us to contact you? Please provide details:

If you feel uncomfortable putting this information on a form, please feel free to email Dr Riches.

Thank you for your enquiry. Frith will aim to respond within a few days.