Suffolk Children and Young People’s Emotional Wellbeing Hub

Information Sharing Form – Concerned Adults & Practitioners
This form is designed for parents, carers, practitioners and other concerned adults who are seeking support from the Emotional Wellbeing Hub regarding a child or young person’s mental health or emotional wellbeing. The Hub is for children and young people aged 0-25 who are registered with a GP in East or West Suffolk. Please ring the following number if you would like additional information prior to submitting a referral:
Telephone: 0345 600 2090, Monday to Friday 8am – 7:30pm
For a medical emergency, dial 999.

1. Initial Screening

2. Details of the concerned adult or referring professional

3. Details of the child or young person

4. Emotional Wellbeing

5. Safety

6. Goals

In coming to this service, what would you like to be different or what are the main goals you want to get to? Please answer these questions from your own point of view (as a concerned adult) about what you would like to see change.

7. Family Network

Contact details for family members and other important connected people (please include at least one person with parental responsibility)

8. Other services currently or previously involved