Referral – Canopi

Canopi provides a free and confidential mental health support service for NHS and social care staff in Wales.

Please note, we are not an emergency service. If you need help immediately, click here.

Self-Referral form

Need to talk? If you would like to access support through Canopi, fill out the form below and we will email you within one working day.

Please also note: to assist us in providing the best possible service, Canopi will not usually accept self-referrals where individuals are already receiving, are about to start, or recently finished psychological treatment or therapy from another care provider or source of support. In these instances, we would encourage you to discuss the reasons you are seeking additional help with your existing care provider or your GP.

Referral

If you feel that you may be experiencing a crisis, please dial 999 or visit our Help in a crisis page.

I do not think that I need emergency help for my mental health and am able to keep myself and others safe.*

Before submitting your referral, please confirm the following:

I, as the individual wish to receive mental health support from Canopi and confirm that I am aged 18 years or over.

I am not currently receiving psychological treatment or therapy from another care provider.*

I have not accessed Canopi’s services before/ it has been at least 12 months since I last accessed support from Canopi.*

Your full name / Eich enw llawn *

Email / Ebost *

Please confirm your email address again in the box below. This must be an address which you have regular access to.

Confirm Email / Ebost *

Phone / Ffôn *

Are you employed to work in the NHS or in social care in Wales? / Ydych chi’n cael eich cyflogi i weithio yn y GIG neu ym maes gofal cymdeithasol yng Nghymru? Are you employed to work in the NHS or in social care in Wales? / Ydych chi'n cael eich cyflogi i weithio yn y GIG neu ym maes gofal cymdeithasol yng Nghymru?

Employment organisation / Sefydliad cyflogaeth

This information will be used to determine your eligibility for the service, and your employer will NOT be notified.

Profession or job role / proffesiwn neu swydd *

Have you used the service before? If so, who was your Wellbeing Ally or Therapist? / A ydych chi wedi defnyddio’r gwasanaeth o’r blaen? Os do, pwy oedd eich neu Cymorth Cynghreiriaid Lles neu Therapydd?

Where did you hear about the service? / Ble clywsoch chi am y gwasanaeth?

If you are human, leave this field blank.

What happens next?

Once you have completed the referral form, you will be emailed within one working day to confirm your details. You will also be asked to complete a short form which asks how you have been feeling recently
Once we receive this from you, you will be sent a link to book an appointment with a doctor advisor
At the time of your confirmed appointment, the Doctor Advisor will call you from a withheld number. Please check your junk mail so that our emails are not missed.

FAQs

What is the aim of a Doctor Advisor appointment?

The aim of the appointment with the Doctor Advisor is to have a discussion in a safe and confidential environment, and to listen to the issues that you have. Then we can determine if and how our service can assist you further.

In the event that you are not suitable for our service, we can explore whether there are more appropriate routes for you to receive help.

Doctor Advisor availability

Canopi Doctor Advisor appointments are available between 9am and 8pm on Monday – Friday (excluding bank holidays).

I have not received my appointment confirmation

Please allow up to one working day to receive your confirmation email and check your junk mail folder before contacting the team.

Where will my details be shared?

Canopi is a confidential service. For more information on how we use and take care of your data, visit our privacy policy.