What is the CAMHS referral form?

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In this blog we present to you a sample of the CAMHS form. 

We will also briefly discuss what CAMHS forms are, and what CAMHS is. 

What is the CAMHS referral form?

A CAMHS referral form refers to the Child and Adolescent Mental Health Service referral form that you or the person who is referring you to CAMHS have to fill. 

The form must be filled up with current data and it is advised that the person themselves fill up the form, however if they are too young or are unable to because of disabilities, you can consider filling it up with them in order to get the most accurate and relevant information. 

If you are referring someone to CAMHS, the form should be completed with them present in order to get the most up to date information.

While filling up the form it is also important that you choose the correct CAMHS location you are looking to attend as well as to accurately identify who they accept referrals from. It is important to note that the form can have differences in composition and content depending on the location. 

It is important that in order to refer someone to CAMHS and before filling up the form, you must have consent of the individual and the guardian’s of the individual (in case they are minors) if you are not their legal guardians. 

The CAMHS form can also be accessed online from the National Health Services (NHS) linked to the Dorset HealthCare University here.

Another version of the CAMHS form by the government of western australia can be accessed here

Below we provide you a sample of the Child and Adolescent Mental Health Service referral form that is used in London. 

Sample of Child and Adolescent Mental Health Service referral form (CAMHS)

☐ Ealing CAMHS1 Armstrong WaySouthallMiddlesexUB2 4SA
Tel: 020 8354 8160E- mail referrals to:[email protected]
☐ Hammersmith & Fulham CAMHS48 Glenthorne RoadHammersmithLondonW6 0LS
Tel: 020 8483 1979E-mail referral to:[email protected]
☐ Hounslow CAMHSHeart of Hounslow Centre for Health92 Bath RoadHounslowTW3 3EL
Tel: 020 8483 2050E-mail referrals to:[email protected]
CAMHS Consultant helpline for Hounslow patients ONLY020 8483 2452Every Tuesday 12 noon to 1pm
CAMHS Referral form for use from May 2018

Please email this completed form to your local CAMHS Service. Faxes will no longer be accepted from 1st July 2018.

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.

Date of Referral
PRIORITY(see separate guidance)☐ Routine  ☐ Urgent☐ Emergency
Child/Young Person (Patient) DetailsParent/Carer/Guardian Details
First NameName of Mother
NHS NoHome or Mobile Tel
GenderName of Father
AddressHome or Mobile Tel
Area of ResidencyEmail
Home TelName of Carer/ Guardian if applicable
Mobile TelAddress if applicable
Home or Mobile Tel if applicable
Email if applicable
Status☐Single  ☐Other ☐Not SpecifiedMain residence of child/young person
Main Language spokenMain language spoken by family
Learning Disability☐No ☐YesLearning Disability☐No ☐Yes –
Physical Disability☐No ☐YesPhysical Disability☐No ☐Yes
Interpreter☐No ☐YesInterpreter☐No ☐Yes
GP Name if not referrerWho holds parental responsibility?(give details e.g. parent/carer/Local Authority (LAC) include name and contact details if not already shown above)
GP Phone No
GP Address if not referrer
GP admin email address if known
School/Collegeif applicable
School/College Phone No
Special School☐No ☐Yes
Referrer Details
NameOrganisation code if applicable
Role/TitleTelephone No
OrganisationEmail admin (NHS or egress)

Consent – if this section is not completed fully, the referral will be returned to you prior to triage
Has the child/young person/family had previous involvement with this or any other CAMHS☐Yes☐No
Do the parents/carer/guardians (who have parental responsibility) consent to this referral to CAMHS☐Yes☐No
Do the parents/carer/guardians (who have parental responsibility) consent to this referral to CAMHS being shared with another more appropriate NHS or Local Authority Service? This includes being sent to another Trust such as CNWL.☐Yes☐No
If no, are the parents/carer/guardians (who have parental responsibility) aware of this referral?☐Yes☐No
If the young person is 16 years and over, does the young person consent to this referral to CAMHS☐Yes☐NA
If the young person is 16 years and over, does the young person consent to this referral to CAMHS being shared with another more appropriate NHS or Local Authority Service? This includes being sent to another Trust such as CNWL.☐Yes☐NA
If the young person is 16 years and over, does the young person consent to this referral being shared with their parents/carer/guardians?☐Yes☐NA
Are there any other matters such as culture, language, illness, religion or disability that we may need to consider when getting in touch. If you have indicated that there is a learning or physical disability affecting the Child/Young Person or family member, please specify here:☐YesGive Details:☐No
Reason for Referral
Reason for Referral(Please specify why you think a CAMHS assessment is required and what you wish the service to do)
Main Concerns – Symptoms(Give details about onset, duration, frequency, severity)
Settings (Home, School and Community)(Neurodevelopmental disorders and other mental health conditions are pervasive across settings – home, school and community. Give details in relation to different settings)
Impact, Distress and Impairment(Give details of child development, family life, social life, learning/academic performance)
Risk /Safeguarding Concerns
Is the family known to Children’s Social Services?☐No ☐Yes  ☐UnsureIf yes give details:
Does the child have an Education, Health & Care Plan (EHCP), Child Protection (CP) Plan, Child in Need (CIN) Plan?☐EHCP  ☐CP ☐CIN
Is the child/young person a Looked After Child (LAC)☐No ☐Yes  ☐Unsure
Is the child/young person/family currently involved in Legal Proceedings relating to the child/young person?☐No ☐Yes  ☐UnsureIf yes give details:
Are you aware of any domestic violence or abuse issues in this family?☐No ☐Yes  ☐UnsureIf yes give details:
Are you aware of any drug or alcohol issues in this family?☐No ☐Yes  ☐UnsureIf yes give details:
Medical History(Give sufficient details to rule out organic conditions)
Current Acute Medication in last month
Current Repeat Medication
Allergies & Sensitivities
Interventions Previously Tried (Individual and/or family)(Give details of school, universal/primary/secondary interventions)

Other Professionals Involved
Other Professionals Involved and Reports(Give details of other agencies involved now or in the past with the child/young person and family)Agency NameNamed WorkerAddressTel No
Is the child/young person on a waiting list for a service?☐No ☐Yes  ☐UnsureIf yes give details:
Relevant reports attached☐No ☐YesIf No, please give reasons as this may significantly delay the processing of this referral:Please state which reports are attached

What is CAMHS?

CAMHS is the abbreviated term for Child and Adolescent Mental Health Services which is part of the National Health Services (NHS) around the UK.

CAMHS as an NHS service assess and treats young people- children and adolescents for emotional, behavioural, and mental health difficulties and challenges that they generally go through. 

Child and Adolescent Mental Health Services includes psychiatric care and counselling for conditions such as depression, problems with food and eating, self-harm, abuse, violence or anger, bipolar disorder, schizophrenia and anxiety, among other difficulties.

The CAMHS services are available throughout the UK and are tied up to various treatment facilities, nurses, therapists, psychologists, child and adolescent psychiatrists (medical doctors specialising in mental health), support workers and social workers, as well as other professionals (YoungMinds).

A young individual will be referred to the CAMHS for an assessment by parents/carers, a teacher, GP, or yourself if you are considered capable and above 16 years old. 

In the case that you are part of a group of young offenders, or in social care, the individuals who supervise and care for you will refer you to the CAMHS.

After you have been referred you will most probably be put on a waiting list for an initial appointment so that you can be assessed- this is a normal procedure and it is mostly conducted so that the CAMHS team can get to know you and also understand what kind of help you need. 

At this appointment or assessment that you will have at a CAMHS tied clinic, you will most probably have a chat with one or two CAMHS members and in case you are under 16, your parents or legal guardians will also be required to join. 

In some cases, this appointment might also occur at your home or at school, this will be decided upon with you so that you and the team can consider what is most appropriate. In the case you are in detention for any juvenile offences, the CAMHS workers will most probably come to the rehabilitation center. 

Here are some common assessment questions the CAMHS team may ask include:

  • What has brought you to CAMHS?
  • How long have you experienced the problem that has brought you to CAMHS?
  • What would you like to change in your life?
  • What might help tackle the problems you are experiencing?
  • How have you been feeling recently?

The session will most probably be short and include no interventions as this is only an assessment. Towards the end of the session, the interviewing members will direct you as to what will happen next and also suggest what treatments will be needed and what support you might need- psychiatric support, financial aid etc. 

It is required that, if you are 16 years or less, your legal parents will have to accompany you to the session for assessment; however, in the case that you want privacy- you can request that the assessment be carried out in private if it is necessary.

After the assessment the treatment plans will also be discussed as well as issues related to getting psychiatric or pharmacological care for your condition; services will be provided and suggested by the CAMHS team. 


In this blog we presented to you a sample of the CAMHS form. We have also briefly discussed what CAMHS forms are, and what CAMHS is. 


Community Child & Adolescent Mental Health Service (CAMHS) Referral Form. Government of Western Australia. Retrieved on 15th March 2022. 


CAMHS self-referral form. Dorset Healthcare University. Retrieved on 15th March 2022. https://www.dorsethealthcare.nhs.uk/patients-and-visitors/our-services-hospitals/mental-health/child-and-adolescent-mental-health-camhs/camhs-self-referral-form

Guide to CAMHS. YoungMinds. Retrieved on 15th March 2022. https://www.youngminds.org.uk/young-person/your-guide-to-support/guide-to-camhs/

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