The Debt and Mental Health Evidence Form allows you to provide us with information about your mental health situation, so that we understand what help you need and so we can offer the right support.
Please follow the instructions on the form and liaise with your chosen health or social-care professional.
This is a standard form so you can also use it with other financial service providers, like your bank. It has been created and developed by the Department of Health and Social Care, along with the British Medical Association, Money and Mental Health Policy Institute, Money Advice Trust, UK Finance, the Credit Services Association and other key stakeholders.
Download a copy (PDF)