Referral – Canopi

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

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

Self-Referral form

Need to talk? Fill in the referral form below and one of the team will get in touch.

Please also note: to assist us in providing the best possible service, Canopi will not usually accept self-referrals where individuals are already receiving or are about to start 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

Your full name / Eich enw llawn *

Email / Ebost *

Please confirm your email / Cadarnhewch eich e-bost

Confirm Email / Ebost *

Phone / Ffôn *

Profession / Proffesiwn *

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?

Best time to contact you / Amser gorau i gysylltu â chi *

You will be sent an appointment time with one of our Doctor Advisors. Please let us know when you are available between the hours of 9am – 5pm on Monday – Friday. Bydd amser apwyntiad yn cael ei anfon atoch gydag un o’n Meddygon Cynghorol. Rhowch wybod i ni pan fyddwch ar gael rhwng 9am a 5pm ddydd Llun i ddydd Gwener.

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

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?

By checking this box, you consent to receive automated texts from Canopi Cymru relating to your appointment. Standard messaging and/or data rates may apply. To opt out of this service, text “STOP” / Trwy wirio’r blwch hwn, rydych yn cydsynio i dderbyn negeseuon testun awtomataidd gan Canopi Cymru ynglŷn â’ch apwyntiad. Gall ffïoedd negeseuon a/neu ddata safonol fod yn berthnasol. Tecstiwch “STOP” i ganslo.

I consent to receiving automated texts from Canopi regarding my appointments / Rwy’n cydsynio i dderbyn testunau gan Canopi ynglŷn â fy apwyntiadau.

What happens next?

Once we’ve received your self-referral form, we will make an appointment for you to have a telephone call with one of our Doctor Advisors.

You will be emailed within one working day, confirming your details, along with the time and date of your telephone appointment.

Please be aware that our response may be in your junk folder.

FAQs

Dr Advisor availability

Canopi Dr 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.