Hull and East Riding CAMHS Professional Referral Form

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1. Child and Adolescent Mental Health Service professional referral form (CAMHS)

 
The personal information collected in this form is secured using SSL (Secure Sockets Layer) encryption – the standard security technology for establishing an encrypted link between a web server and browser.  This link ensures that all data passed between us remains private.  This is indicated by the https:// url address and the padlock  symbol that appears at the top of the page in the address bar.  Further information about security can be found at: https://www.smartsurvey.co.uk/security 

The Trust will process personal information in line with our fair processing information detailed at http://www.humber.nhs.uk/data-protection.htm
 
Please be aware that this referral form is hosted by a third party service provider.  This provider will collect your IP address and information about your visit to the website.  Further information can be found at https://www.smartsurvey.co.uk/privacy-policy.
 
All data is hosted within the UK.

Note - If you do not press 'submit' on the last page of the form it will not be received and processed by the CAMHS service.

 

1. Priority of referral *

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