Referral

Support for Mild to Moderate Mental Health Needs

By making this referral, the parent/carer and young person agree to sharing information with other agencies and organisations as necessary to support their needs most suitably. Information will be shared with trusted partner agencies and recorded on their medical health record. Information about the referral will also be sent to the GP.

Who is making this referral? Required

Professional

Carer/Parent

Self

The person I am referring is in the following age group Required

What is the young person’s view of this referral? Required

The parent/carer is aware of the referral and has given consent for the referral.

The young person is aware of this referral and has given consent for the referral.

I give consent for this referral

The child/young person being referred is aware of the referral and has given consent for the referral.

I confirm that I am aged 14 or over. Anyone aged under 14 wishing to make a self-referral should seek support from a parent/carer or trusted adult, or call Just One Number on 0300 300 0123