CAMHS Referral Form

Referral made by professionals

This form should be completed while logged into a secure work computer which only you have access to.

Important: If the referral is urgent, please call the relevant CAMHS service in addition to submitting the referral online.


No referral can be accepted without the consent of the child or their parent/guardian. Please select applicable consent.


Child or young person's details

Important! Please give the child or young person's legal name as registered with their GP.


Child or young person's contact information

Phone and email

The more ways we can contact the young person, the faster we may be able to process the request for service.


Postal address


Child or young person's background





GP details




About the principle parents / main carers (expandable)



If you wish to add any other information you think is relevant, please tick here.

Reason for referral

Please let us know why you are making this referral, including details of any previous or current mental health problems.

The more information you include, the better we can decide on how best to help the young person.

Please describe any mental health difficulties they might be having, e.g. worries, sadness, anger, changeable moods or feelings, self-harm etc.


How long have these been affecting them?


What impacts have these had on the young person, and have these had any impact on their family, school work or friends?


Please tell us:

  • Impacts on the young person: e.g. sleep, appetite, motivation, self care, etc.
  • Impacts on relationship with those around them.
  • Are they still communicating with friends?

Has anything happened recently to make them seek help at this time?


Please tell us:

  • Have there been any interventions that have already been tried (including self help websites)?

Have there been any big family events or illnesses recently?


Is there any further information that you/they think we should know?


Please include answers to these questions:

  • Do they still go to school?
  • What activities do they enjoy doing?
  • Are they still motivated?
  • Has there been a change to concentration at school?
  • Have they thought about harming themselves and have they acted on these thoughts?

Eating disorders

Are there concerns about the young person's eating?


Other professionals

Is the young person currently working with, or have they worked with, any other agencies, people or organisations, including their school?


Referrer details


Information sharing

Oxford Health NHS Foundation Trust delivers a wide range of high quality healthcare services in partnership with many other organisations including the public, charities, voluntary, third party and private sector.

To ensure we deliver the best care for our patients without the need to constantly repeat themselves we share only the minimum amount of information required for our partners to provide the continuity of care our patients expect.

By engaging with Oxford Health NHS Foundation Trust you consent to your information being shared between our relevant partners as described above.

All patient information is held securely, and access is controlled in accordance with the Data Protection Act 1998.

Oxford Health NHS Foundation Trust's privacy policy can be accessed here:

I agree to information being shared between agencies.



If you wish to retain a copy of your referral for your own records, please print the page before clicking Submit.