Professional Referral Form

Children or Young Person (CYP) Details:

Reason for referral: – to avoid a delay, please answer all questions fully

Referral Details:

Parent/Carer Details:

Your Details:

Low intensity cognitive behavioural therapy (LI-CBT) requires a commitment on the part of the child or young person to engage, complete the practice tasks and attend every session for the therapy to be successful. Therapy should be completed within a 6-8 week time frame.
If children and young people do not attend their sessions then it will be considered that LI-CBT is not suitable for them at this time and they will be discharged.

All personal data will be processed by Young Somerset (YS) and Somerset NHS Foundation Trust in accordance with the Data Protection Act 1998 & 2018 General Data Protection Regulation and in accordance with Young Somerset’s and Somerset NHS Foundation Trust Data Protection Policy and Guidelines. For full details of how we use and store your data please see our Privacy Statement and Data Protection Policy: