West Coast Health - Youth Mental Health - Youth-Mental Health Referral Form (12yrs-24yrs)

Referrer Details

Provider Details
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Address
Physical Address
Postal Address

Client Details

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Contact Details
Address
Residential Address
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Referral Details

Youth-Mental Health Referral Form


NOTE: If the young person is over 16 years old their parents / guardians do not need to be involved.
If the young person is under 16 years old, it is important that the parent or guardian is aware of the referral unless under exceptional circumstances this is not in the best interest of the young person.

Referrer Details

Please provide as much background information as possible, why you are referring into our mental health service, and what you would like to get out of the service, e.g goals for counselling. Please make sure you have included the main reason for request clearly.

Provide brief summary of when CAMHS was involved, how long for, treatment received, and approximate discharge date.
Note: If this referral is coming from CAMHS directly a full discharge letter must accompany this referral.

Risk Assessment