FIRST POINT OF CONTACT (FPoC) REFERRAL FORM

The First Point of Contact is the single entry point for all CAMHS referrals.
The First Point of Contact also provides telephone support and guidance. Referrers are invited to phone the First Point of Contact on 01422 300 001 if they would like to discuss a case before submitting a referral.
We would always advise referrers to phone about crisis/urgent cases, or where suitability for CAMHS is unclear.
Please note that this on-line referral tool is not supported by the Internet Explorer 10 web browser (or older versions of Explorer). Referrers are encouraged to use a more recent web browser such as Chrome.
Please ensure that you are in a position to fully complete the form before starting to enter the referral information as it is not possible to save partially completed versions.
If preferred the referral form can be downloaded from the Calderdale CAMHS website. The completed form can then be posted to us at the address on the form.

About the Young Person:

Consent:

About the Referrer:

Other Agency Involvement:

Please make the young person and/or family aware that we may need to contact some or all of the professionals and agencies named below in order to gather further information and reach an informed decision.

GP:

School/College:

If ‘YES’ send us the details according to the instructions at the bottom of this form, if available.

CAMHS:

Safeguarding:

Risk Factors:

Reason for Referral:

What is the particular issue you are seeking help or advice about? Please give details of emotional or mental health difficulties, when these started, and how the problem is seen at school and at home, what interventions have been tried etc.
Please identify any risk factors and specialist needs e.g. safeguarding concerns, poor mobility, sensory impairment, learning difficulties, literacy problems, substance misuse, need for interpreter, parental agoraphobia or risk of violence.

Additional Documentation:

Please e-mail the documentation as an attachment to firstpointofcontact@calderdalecamhs.org.uk. Please note - this email address may not meet the security requirements of your organisation. If preferred, post it to CAMHS First Point of Contact, 9 Clare Road, Halifax, HX1 2HX.
Please note that you may be asked to go back and complete any missing information before the form can be successfully submitted. Please don't close the page until you have received an on-screen message which is confirmation that we have received the referral. The system does not enable us to automatically send you a copy of the referral form but we would be happy to post one to you on request.