Make a self-referral

  1. Introduction
  2. Your details
  3. Your GPs details
  4. Your concerns
  5. How to contact you
  6. Overview

Before we get started

Please respond to the following questions to the best of your knowledge.

Only the questions marked with * are mandatory but all questions will help us respond to you in the best way.

Please note: This service is only available for young people up to the age of 18 registered with a GP in one of the following boroughs: Bexley, Bromley, Croydon, Greenwich, Lambeth, Lewisham and Southwark


After you submit your form, a member of our team will contact you the next working day. If you do not hear from us on the next working day after you have submitted your form, please give us a ring on 020 3228 2545.

Please enter your GPs postcode *

If you don’t know your GP’s postcode, the NHS GP finder is an easy way to get it.

Sorry, our outpatient service 
is not available in your area.

Made a mistake with your GP postcode?
Try again

If you entered the correct GP postcode sorry, our outpatient service is only available for young people up to the age of 18 registered with a GP in one of the following boroughs: Bexley, Bromley, Croydon, Greenwich, Lambeth, Lewisham and Southwark.

There are other specialist eating disorder services in London, please contact your local GP for more information. If you would like any more information on eating disorders, visit our Getting Help page.

First, we’ll need to know a little more about you.

Your date of birth *


* Required field* Required field – we still need information in the following sections* Sorry, this service is for under-18’s only

Next, we’ll need to know about your GP.

Don’t worry! We won’t contact your school or college without your consent.

Are you in contact with any other health services?


* Required field* Required field – we still need information in the following sections

How can we help you?

Have you been experiencing any of the following?

Please select all that apply


* Required field* Required field – we still need information in the following sections

Almost there! Just let us know how to reach you.

Finally, we’ll need a parent or carer’s contact details.

Please ensure that you’ve given us the right contact number, and let us know which times between 9am to 5pm, Monday to Friday, would be best to phone you back. We cannot complete our referral process until we have spoken to you.

If we cannot contact you within one week, we’ll assume that you have changed your mind about the referral.


* Required field* Required field – we still need information in the following sections

Overview

Your details

Edit
Name
Date of birth
//
Gender
Address
City / Town
Postcode

Your GPs details

Edit
Your GPs Postcode
The name of your GP or Surgery
What school or college do you go to?
Is there any other health service involved?

Your Concerns

Edit
Please summarise your concerns:
What is your height in cm?
What is your weight in kg?
How has your weight changed over the last month?
Is there anything else you would like us to know that we have not asked you already?
Have you experienced any of the following?

How to contact you

Edit
Your phone number
Your email
Parent or carers name
Their phone number
Their email address
Their relationship to you
Are they aware of your contact with our service?

Please make sure all of the information is correct before submitting the form


Your privacy is important to us. To understand how we collect and use your data please read our Privacy Policy

Congratulations!

Your referral has been submitted, What happens next?

Once you’ve submitted your form, we’ll get in touch on the next working day to schedule your first appointment. If you haven’t heard from us by then, please call us on 020 3228 2545. Our office is open Monday to Friday, from 9am to 5pm.

Once we’ve accepted your referral, we’ll aim to get you booked in to see us within 28 days.

Your handy downloadable information pack will tell you everything need to know about your first appointment with MCCAED. Please make sure you read it thoroughly!

We look forward to meeting you in person.

We use cookies to give you the best online experience. By agreeing you accept the use of cookies in accordance with our cookie policy.

Privacy Settings saved!
Privacy Settings

Cookies are files saved on your phone, tablet or computer when you visit a website. They store information about how you use the website, such as the pages you visit.

These cookies are necessary for the website to function and cannot be switched off in our systems.

In order to use this website we use the following technically required cookies
  • wordpress_test_cookie
  • wordpress_logged_in_
  • wordpress_sec

Decline all Services
Accept all Services