SELF REFERRAL FORM

At DHC we aim to provide quality healthcare in local setting for the benefit of patients.

 

To refer yourself for treatment please complete the following form and 
we will be in touch.

(DD/MM/YYYY)



for example, Bi-polar, Schizophrenia or a personality disorder

Sometimes when people are experiencing emotional distress they can have thoughts that life is not worth living or harming themselves in some way.
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