Signed (GP/Healthcare Professional): Name (please print): Return this form to: Self Help 1st East By Post Oakland House, 76 Talbot Road Old Trafford, Manchester M16 0PQ By email If you want help accessing our services or wish to cancel an appointment please contact the office between 9:00am 5:00pm. – By telephone: 0161 226 3871 By fax 0161 877 2740
Signed (GP/Healthcare Professional): Name (please print): Return this form to: By Post Self Help 1st East Oakland House, 76 Talbot Road Old Trafford, Manchester M16 0PQ By email If you want help accessing our services or wish to cancel an appointment please contact the office between 9:00am – 5:00pm. By telephone: 0161 226 3871 By fax 0161 877 2740
Referral-Form-Health-Professional-PWS-Manchester-SH081-v1.docx