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North Lincolnshire CAMHS online referral form






    Request for advice and/or support

    Is the request urgent?

    Is the person currently suicidal with intent?

    If "Yes", please follow up this referral with a telephone call (01724 408460). Also please ensure that you work with the person to implement a safety plan.
    Is informed consent given?



    If the person is over 14 years old, have they given consent?

    Please note we cannot accept any requests for advice or support without consent.
    Is this request for professional consultation and advice?

    Is this request for specialised mental health support?

    Person's details













    Preferred contact method:



    Interpreter required?




    Does the person have an identified learning disability?

    Education healthcare plan:

    Legal status (e.g. LAC):

    Child protection plan or child in need:

    Early help support:

    Neurodevelopmental diagnosis?

    Parent or guardian details (if person is under 16 years old)










    Preferred contact method:

    Referrer's details










    Reasons for request for support/advice

    Symptoms/presenting problems

    Eating disorders:

    Anxiety:

    Depression:

    Post-traumatic stress disorder (PTSD):

    Obsessive compulsive behaviours:

    Phobias:

    First episode psychosis (suspected):

    Risk factors

    Suicidal thoughts:

    Harm to self:

    Harm to others:


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