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Hertfordshire Mind Network
Hertfordshire Mind Network
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Hertfordshire Mind Network Referral Form

Please complete this form if you would like to access our services and we will contact you to discuss next steps. Please give as much information as possible.

Your Details

Name *
Please tick all the ways that we can use to contact you? *
Is it OK for us to leave a message on your mobile?
Do you need an interpreter?

Emergency contact details

In the event of an emergency, who would you like us to contact?

GP Surgery

Employment information

Employment information *

Housing status

Are you homeless, in temporary accommodation, or facing eviction? *
Housing status *

Hospital admission

Have you been discharged from Watford A and E, Lister A&E, Kingfisher Court or Albany Lodge within the last 7 days? *

One to One Services

Which 1:1 service would you like to access? (If you are unsure of which service you would like to access, please call 0203 727 3600 Mon to Fri 9am - 5pm to discuss) *

If you would like to access counselling, please visit our counselling section and find out how to refer to these services

Groups

If you would like to attend groups and activities, which one(s) interest you? *

Further information

How did you hear about us?

Details of referrer

(if completing the form on behalf of someone else)

Are you a professional completing this form on behalf of someone?

Equal Opportunities and Disability Monitoring

Age Group *
Gender *
Religion/ faith *
Sexual orientation *
Disability: Are your day-to-day activities limited because of a health problem or disability which has lasted or expecting to last for at least 12 months? *
Ethnicity *
Relationship status
Caring responsibilities
Autism
ADHD

Data Protection and Confidentiality

Hertfordshire Mind Network adheres to the Data Protection Act 2018’s principles of good information handling and the EU General Data Protection Regulation 2018.
 

Please indicate below if you consent to us collecting, recording and processing your personal data for the purpose of providing you with support and to ensure your health, safety and wellbeing. We will use your information appropriately and in line with our Privacy Policy which you can see here: Privacy Policy
 

Your details will not be shared with anyone else without your consent. If you have any concerns or questions about how your personal data is collected and used, please ring us on 02037 273600 or email us at info@hertfordshiremind.org. Please note that without your consent, you will not be able to submit this form and access Hertfordshire Mind Network’s services.
 

Where information is given in confidence that Hertfordshire Mind Network believes poses a risk to the client, a risk to other people, a risk to the safety and welfare of a child, or is against the law, we reserve the right to disclose that information to a relevant third party.

Do you consent to us collecting, recording and processing your personal data for the purpose of providing you with support and to ensure your health, safety and wellbeing? *
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Search our site

  • Home
  • Who we are
    • About us
    • Our vision, purpose and values
    • Our impact
    • Our Leadership Team
    • Our Trustees
  • For Adults
    • Search for Services for Adults

      Filter all our services to find the services that might be right for you.

    • the photo shows a desk inside containing a laptop computerMental Health Information

      When you’re living with a mental health problem, or supporting someone who is, having access to the right information about a condition, treatment options, or practical issues, is vital.

    • Crisis Support
      • Nightlight Crisis Helpline
      • Nightlight Crisis Cafés
      • Nightlight Crisis House
      • A and E Crisis Liaison Service
    • Community Support
      • Bounce Back
      • Community Support Service
      • Complex Needs Housing Service
      • Domestic Abuse Service
      • Flourish – Refugee and Asylum Seeker Service
      • Growing People
      • Housing Support Service
      • Primary Care Network Service
      • Social Support
    • Peer Support Service
      • 1:1 Peer Support
      • Peer Learning Courses
      • Peer Mentoring
      • Peer Support Academy
      • Peer Support Groups
      • Carers Support
    • Employment
      • Employment Support
      • Care Leavers Employment Support
    • Counselling
      • NHS Talking Therapies – Counselling
      • Talk It Out Counselling
      • Talk it Out Counselling Payment Form
      • Counselling Placements
    • Groups and Activities
      • Decluttering Peer Support Group
      • LGBTQ+ Group
      • Meeting Places
      • Mums Matter
      • Music Groups
      • Online Carers Group
      • Online Meeting Places
  • For Young People
  • Training
  • Support us
    • the photo shows four piles of coins on top of soil, with green plants emerging from the top of the coinsDonate to us

      Your donation will make a real difference to the lives of people experiencing mental ill health in Hertfordshire.

    • Thank you to all those who donated

      A huge thank you to all our donors, your support is changing the lives of people in our community.

    • Fundraise for your local Mind
      • Fundraise for us
      • Fundraising ideas and resources
      • Legacy Giving
      • Give a Car
    • Corporate Fundraising
      • Mindful Partners
      • Corporate Volunteering
    • Our Events
      • Community Events
      • Helping Herts Events
      • Firewalk
      • Watford Half Marathon 2027
  • Join us
    • Work for us
      • Community Outreach Worker (Complex Needs Housing)
      • Community Outreach Worker (CSS)
      • Community Support Worker (PCN)
      • Horticultural Therapist (The Sadie Centre)
      • Student Placement (unpaid)
    • Volunteer with us
      • Carers Peer Support Volunteer
      • CYP ‘Future Youth’ Mentor
      • Gardening Volunteer (The Sadie Centre)
      • Group Volunteer
      • Nightlight Volunteer
      • Peer Mentoring Volunteer
    • Care Leavers Employment Support
    • Board of Trustees
  • Get Involved
    • Client Engagement and Involvement
      • Your Stories
      • Share Your Feedback
      • You said, We did
      • Events Volunteer
    • Community Engagement
  • Latest
  • Contact us
Please enable JavaScript in your browser to complete this form.

Hertfordshire Mind Network Referral Form

Please complete this form if you would like to access our services and we will contact you to discuss next steps. Please give as much information as possible.

Your Details

Name *
Please tick all the ways that we can use to contact you? *
Is it OK for us to leave a message on your mobile?
Do you need an interpreter?

Emergency contact details

In the event of an emergency, who would you like us to contact?

GP Surgery

Employment information

Employment information *

Housing status

Are you homeless, in temporary accommodation, or facing eviction? *
Housing status *

Hospital admission

Have you been discharged from Watford A and E, Lister A&E, Kingfisher Court or Albany Lodge within the last 7 days? *

One to One Services

Which 1:1 service would you like to access? (If you are unsure of which service you would like to access, please call 0203 727 3600 Mon to Fri 9am - 5pm to discuss) *

If you would like to access counselling, please visit our counselling section and find out how to refer to these services

Groups

If you would like to attend groups and activities, which one(s) interest you? *

Further information

How did you hear about us?

Details of referrer

(if completing the form on behalf of someone else)

Are you a professional completing this form on behalf of someone?

Equal Opportunities and Disability Monitoring

Age Group *
Gender *
Religion/ faith *
Sexual orientation *
Disability: Are your day-to-day activities limited because of a health problem or disability which has lasted or expecting to last for at least 12 months? *
Ethnicity *
Relationship status
Caring responsibilities
Autism
ADHD

Data Protection and Confidentiality

Hertfordshire Mind Network adheres to the Data Protection Act 2018’s principles of good information handling and the EU General Data Protection Regulation 2018.
 

Please indicate below if you consent to us collecting, recording and processing your personal data for the purpose of providing you with support and to ensure your health, safety and wellbeing. We will use your information appropriately and in line with our Privacy Policy which you can see here: Privacy Policy
 

Your details will not be shared with anyone else without your consent. If you have any concerns or questions about how your personal data is collected and used, please ring us on 02037 273600 or email us at info@hertfordshiremind.org. Please note that without your consent, you will not be able to submit this form and access Hertfordshire Mind Network’s services.
 

Where information is given in confidence that Hertfordshire Mind Network believes poses a risk to the client, a risk to other people, a risk to the safety and welfare of a child, or is against the law, we reserve the right to disclose that information to a relevant third party.

Do you consent to us collecting, recording and processing your personal data for the purpose of providing you with support and to ensure your health, safety and wellbeing? *
Loading
Get help now Donate

Search our site

  • Home
  • Who we are
    • About us
    • Our vision, purpose and values
    • Our impact
    • Our Leadership Team
    • Our Trustees
  • For Adults
    • Search for Services for Adults

      Filter all our services to find the services that might be right for you.

    • the photo shows a desk inside containing a laptop computerMental Health Information

      When you’re living with a mental health problem, or supporting someone who is, having access to the right information about a condition, treatment options, or practical issues, is vital.

    • Crisis Support
      • Nightlight Crisis Helpline
      • Nightlight Crisis Cafés
      • Nightlight Crisis House
      • A and E Crisis Liaison Service
    • Community Support
      • Bounce Back
      • Community Support Service
      • Complex Needs Housing Service
      • Domestic Abuse Service
      • Flourish – Refugee and Asylum Seeker Service
      • Growing People
      • Housing Support Service
      • Primary Care Network Service
      • Social Support
    • Peer Support Service
      • 1:1 Peer Support
      • Peer Learning Courses
      • Peer Mentoring
      • Peer Support Academy
      • Peer Support Groups
      • Carers Support
    • Employment
      • Employment Support
      • Care Leavers Employment Support
    • Counselling
      • NHS Talking Therapies – Counselling
      • Talk It Out Counselling
      • Talk it Out Counselling Payment Form
      • Counselling Placements
    • Groups and Activities
      • Decluttering Peer Support Group
      • LGBTQ+ Group
      • Meeting Places
      • Mums Matter
      • Music Groups
      • Online Carers Group
      • Online Meeting Places
  • For Young People
  • Training
  • Support us
    • the photo shows four piles of coins on top of soil, with green plants emerging from the top of the coinsDonate to us

      Your donation will make a real difference to the lives of people experiencing mental ill health in Hertfordshire.

    • Thank you to all those who donated

      A huge thank you to all our donors, your support is changing the lives of people in our community.

    • Fundraise for your local Mind
      • Fundraise for us
      • Fundraising ideas and resources
      • Legacy Giving
      • Give a Car
    • Corporate Fundraising
      • Mindful Partners
      • Corporate Volunteering
    • Our Events
      • Community Events
      • Helping Herts Events
      • Firewalk
      • Watford Half Marathon 2027
  • Join us
    • Work for us
      • Community Outreach Worker (Complex Needs Housing)
      • Community Outreach Worker (CSS)
      • Community Support Worker (PCN)
      • Horticultural Therapist (The Sadie Centre)
      • Student Placement (unpaid)
    • Volunteer with us
      • Carers Peer Support Volunteer
      • CYP ‘Future Youth’ Mentor
      • Gardening Volunteer (The Sadie Centre)
      • Group Volunteer
      • Nightlight Volunteer
      • Peer Mentoring Volunteer
    • Care Leavers Employment Support
    • Board of Trustees
  • Get Involved
    • Client Engagement and Involvement
      • Your Stories
      • Share Your Feedback
      • You said, We did
      • Events Volunteer
    • Community Engagement
  • Latest
  • Contact us

Herts Mind Network

The Wellbeing Centre
501 St Albans Road
Watford
Hertfordshire WD24 7RZ

020 3727 3600
info@hertfordshiremind.org

Charity Number: 1112487
Registration Number: 5532977

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RollerCoaster Group provides support for people with bipolar

RollerCoaster Group provides support for people with bipolar

RollerCoaster is a bipolar self-help group based in Dacorum, Hertfordshire.  This friendly group meet on […]

Posted on: 9th November 2021

Walking football marathon raises vital funds!

Walking football marathon raises vital funds!

On Saturday 18th September Dave Knight held a walking football marathon, inviting people of all […]

Posted on: 20th October 2021

Win a signed Watford FC shirt!

Win a signed Watford FC shirt!

On Saturday 24th April, Watford FC held a virtual matchday with Hertfordshire Mind Network to help to raise awareness of the essential mental services that we deliver across Hertfordshire. 

Posted on: 6th March 2021

National Volunteers Week

National Volunteers Week

The 1st – 7th June is National Volunteers Week and we wanted to take this opportunity for […]

Posted on: 5th March 2021

Captain Tom 100

Captain Tom 100

The Covid-19 pandemic has had a catastrophic effect on charities, with the cancellation of thousands […]

Posted on: 6th January 2021

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Contact Us

Herts Mind Network

The Wellbeing Centre
501 St Albans Road
Watford
Hertfordshire WD24 7RZ

020 3727 3600
info@hertfordshiremind.org

Terms

  • Privacy Policy
  • Young Person’s Privacy Policy
  • Cookie Policy
  • Accessibility Statement
  • Terms and Conditions
  • Complaints Procedure
  • Safeguarding Statement

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© 2026 Herts Mind Network
Registered in England and Wales 5532977
Charity No. 1112487

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Logo to show that we are registered with the Fundraising Regulator
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Fundraise

Please enable JavaScript in your browser to complete this form.

Your Fundraising Campaign

Please enter as much information as possible. Once submitted it will be reviewed by a member of our fundraising team and we will email you a link to your fundraising page within 72 hours.

Your Name *
This will be used to notify you when your donation form goes live - we will send you a link to your fundraising page.
This will be the name of your page - if you are taking part as a group this can be a team name or your own personal page if you prefer. If you choose to register as a team - there will be only one point of contact.
The amount of funds you want to raise
If you’d like to fundraise for one of our campaigns, please select it from the list.
Choose Fundraise Your Way to start a general fundraising campaign for Herts Mind Network.
Drag & Drop Files, Choose Files to Upload
Please upload an image for your campaign. Must be minimum 600x600 pixels. File formats: jpg, jpeg, png
Example:
Paragraph 1: Who you are
Paragraph 2: Why you are passionate about Herts Mind Network
Paragraph 3: Why others should also support us.
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