Self Referral

Please complete this form to register for the Primary Care Gambling Service. Any information you provide will be held in the strictest confidence.

If you have any problems with this form please email, or call 0300 0300 111 during office hours. If you would prefer to have this form emailed or posted to you, please let us know.

Out of office hours, you can also contact the National Gambling Helpline, operated by GamCare, to arrange a referral – call Freephone 0808 80 20 133 or web chat via (available 24 hours a day).’

self referral

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