Submit a Referral

Referral form

Our CAMHS Service and our Mental Wealth Academy service

CAMHS

Single Point of Access (SPA) is available to make a referral to on; 01865902525. But if you would like some support while doing so feel free to contact 01295221382.

If you are completing this form for someone else please include the following information:

Referrer Name *

First

Last

Phone Number *

Email *

How would you like to be contacted? *

Please complete this section if you are referring yourself or add the details of the person you are referring.

* Indicates required field

Young Person's Name *

First

Last

Phone Number *

Date of Birth? *

Email Address *

How would you like to be contacted? *

Your Message *

Please confirm that the person you have referred here has given consent to be contacted by BYHP and is aware that we will be in touch. Or if you are referring yourself that you give consent to be contacted.

Consent *

Consent has been obtained

Submit