CAMHS self-referral form

Your details
Referrer information
Client information
Parent/carer information
Please note: If we have concerns relating to risk and are unable to contact you, we will contact your parents/carer.
Parent/guardian/carer information
Demographic details
Other family members (if relevant to this referral)
Background Information
Reason for referral
Other help you've tried or been offered
Please describe your concerns about the child/young persons mental health and social wellbeing that have led to this referral being made, and what you are requesting from C-CAMHs. (Please include information on how long the difficulties have been present, in what settings the difficulties are evident, and what support/strategies have been tried so far).
So that we can know more about what other help you've tried/been offered, please tell us who else you've contacted, or what other services you've seen so far
Risk factors relating to the child/young person
I/my family have had some help from:
Care status
Local authority involvement
Child and Adolescent Mental Health (CAMHS)