Self-referral

CAMHS / MHST Referral form

Step 1

Note: Questions marked by * are mandatory

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Welcome to the Nottinghamshire Child and Adolescent Mental Health Service (CAMHS) online referral form.

Your referral will be reviewed within 24 hours and if required you will be contacted as soon as possible.

Please contact CAMHS Single Point of Access (SPA) on 0115 854 2299 if you want to discuss this referral, or support during the above hours.

If you have immediate concerns about your safety or safety of the person you are referring, you can contact SPA on the number above on weekdays until 6pm. Outside of these hours, contact CAMHS Crisis Team on 0808 196 3779 , choosing 'Option 1', Monday-Friday 6pm-10pm, weekends and bank holidays 10am-6pm. Please go to your local A&E outside of these hours.

For support out of these hours, please contact ChildLine on 0800 1111 or Samaritans on 116 123.
Information within this referral will remain confidential. If there is any information that raises concerns about your safety or the safety of others, this information may be shared.

Two separate CAMHS services cover Nottinghamshire. If your GP is within the Nottingham City boundaries then please find information on how to refer to their services by calling 0115 876 4000.

*This is a mandatory field. Are you a:

*This is a mandatory field. Is the young person aware of this referral? In most cases it is important that the young person is aware of the referral

Details about the person being referred

*This is a mandatory field. First name

*This is a mandatory field. Last name

Family name if this is different

*This is a mandatory field. Gender

*This is a mandatory field. Date of birth

*This is a mandatory field. Ethnicity

*This is a mandatory field. Preferred language

*This is a mandatory field. Address

*This is a mandatory field. Postcode

*This is a mandatory field. What is your preferred contact number?

*This is a mandatory field. Parent / guardian email address

*This is a mandatory field. I am happy for the Trust to send me communication regarding this referral to the above email address. If I wish to change this arrangement, I will contact CAMHS and update my preferences.

*This is a mandatory field. What is the best day/time to contact you (Monday - Friday, between 8am and 5pm)? If we can’t contact you via phone, we will try to contact you by e-mail or letter.

*This is a mandatory field. GP Practice

*This is a mandatory field. Which School does the person named in this referral form attend? Please select from the drop down list.

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Self-referral

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