This form should be completed while logged into a secure work computer which only you have access to.
We are required to register the full demographic details (including area of residency, GP details and NHS number) of all referrals. Please include this information in your referral otherwise we will need to return this form to you prior to triage.
Consent to share with other agencies:
Sometimes we may find that CAMHS is not the best service for the young person and there may be another organisation that is better suited to their needs, e.g. Teens in Crisis, Young Gloucestershire, and CAMHS Parent Support Team. In this case it can be helpful to contact other agencies that may be able to help them.
Please let us know why you are making this referral, including details of any previous or current mental health problems.
In this section you might like to include some of the following:
A description of any mental health difficulties the young person might be having.
How long have these been affecting them.
What impact have these had on them and have they had any impact on their family, school work or friends?
Have there been any big family events or illnesses recently?
The more information you include, the better we can decide on how best to help the young person.
e.g. worries, sadness, anger, changeable moods or feelings, self-harm etc.
Please also make a referral to the eating disorders team. You can access their referral form here:
Please attach any additional information you feel is relevant to this referral.
For example, 6 sessions with TIC+ online
For example, 6 sessions with TIC+ online
For example, 6 sessions with TIC+ online