Please click below to complete our online registration form for NHS Practitioner Health. Any information you provide will be held in the strictest confidence. If you have any problems with this form please email email@example.com or call 0300 0303 300 during office hours.
Please note the following information: This online form was created by NHS Practitioner Health (NHSPH) using SmartSurvey. Your answers will only be seen by NHSPH. The following information is NOT recorded or tracked when you complete this form: your IP address, your location, your browser or operating system. SSL (Secure Socket Layer) Connections are enabled. This survey is not indexed by search engines. SmartSurvey use a secure UK-based server.
This form is secured through SSL encryption and your data is password secured at NHSPH, it is only accessible by staff with two factor authentication (only accessible by having a password and a second device with a code).
All data is stored on UK/EU-based servers (for further information can be found at https://www.smartsurvey.co.uk/security)
In addition to these measures once a referral is received all data is removed from the server within two weeks.
If you would prefer to have this form emailed or posted to you please let us know.
Please note that NHS PH is not a crisis service. If you are in crisis or feel unsafe or at risk to yourself or others, then you should contact 111/999, your own GP or attend your nearest Emergency Department/A&E as soon as possible. NHS PH does provide a crisis text service and you can access this by texting "NHSPH" to 85258. The Samaritans: 0161 236 8000 (local call charges apply) or 116 123 (free to call) can also be provide confidential support and are open 24 hours a day.