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Adolescent service self-referral form

  • Young person's details

    This self referral form must be completed by the young person. If you are a professional referring a young person for support please use the relevant form.

  • Name
  • Address
  • If under 18 are parent(s)/carer(s) aware of this self-referral and have they consented to information sharing?
  • Please let young people know the adolescent service will attempt to contact young people via all mediums available including telephone, email, home visits, Skype etc.