How can I refer to Live Well Leeds?

Live Well Leeds is commissioned to work with adults aged 18+ (17+ if they are transitioning from children’s mental health services), who have mild to moderate mental health support needs, throughout the Leeds Metropolitan District or registered with a Leeds GP as defined by NHS Leeds Clinical Commissioning Group (CCG).

We will provide a package of support in the community for up to 6 months.

Live Well Leeds cannot take referrals for individuals with a primary diagnosis of Dementia or Learning Disability and these individuals will be signposted to appropriate support services.

We are currently experiencing some technical difficulties in receiving some referrals made through the Live Well Leeds website.

Please call 0113 219 2727 to make a referral via the phone.

If you wish to check if your referral has been received, please leave 24hrs from the time of referral before calling.

Referral Form

Reason for Referral^*

Source of Referral^*

Referrer Name

Referrer Organisation

Referrer Contact Details

Name^*

Date of Birth^*

Street Address^*

Post Code^* (If unknown, please enter 'unknown')

Telephone^*

Email Address^*

How do you define your gender?^*

Is your gender the same as the gender you were assigned at birth?

What is your pronoun; write your own (eg. he/him/she/her/they/them)

General Ethnicity

Specific Ethnicity

Residence Status

Disability/Sensory Impairment

Communication Needs

Do you give consent for Live Well Leeds to store your information on our electronic database?^*
I consentI do not consent

Further info required at assessment

GP Surgery

Are you subject to a CPA^*
YesNo

Do you have a social worker?^*
YesNo

Do you receive adult and health services?^*
YesNo

Relationship Status

Sexuality

Religion

Do you have a diagnosed Autistic Spectrum Condition or believe you have an Autistic Spectrum Condition but have not been formally diagnosed?^*
YesNo

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Confirm acceptance^*

^*Required Field

Referrals