Suffolk Children and Young People’s Emotional Wellbeing Hub

Information Sharing Form – Child or Young Person
The Emotional Wellbeing Hub is for children and young people aged 0-25 who are concerned about their emotional wellbeing. You can use this form to tell us about yourself, and a practitioner from the Hub will contact you to discuss your concerns with you. You can fill out as much or as little as you like, but please remember to tell us how to get in touch with you. If you prefer, you can phone the Hub on the number below and speak with one of the practitioners:
Telephone: 0345 600 2090, Monday to Friday 8am – 7:30pm
For a medical emergency, dial 999.
If we are concerned that you or someone else might get hurt, we may need to speak with other adults about it, including your parent or carer.

1. Emotional Wellbeing

2. Safety

3. Goals

In coming to this service, what would you like to be different or what are the main goals you want to get to?

4. Your details

5. Family network

Contact details for your family members and other important people (please include your parents or carers)

6. Other support services you have used