Child & Adolescent Referral Form

GP Referral Form: Assessment for Adolescent Services, Granada Healthcare. All referrals to our Adolescent Services are reviewed by our Referral & Assessment Clinical team and allocated to the most appropriate service.

Young Person Details

Parent Contact Details

Referrer's Contact Details

Referral Details

(including admissions if applicable)
(past and current)

Insurance Details

I understand that I retain clinical responsibility for this client until they are seen by Granada Healthcare.
I have consent from (parent(s)/guardian(s) for a member of Granada Healthcare adolescent referral team to make initial phone contact with one or both parents/guardians of the young person if required to conduct via telephone a prompt assessment of needs to help determine suitability for SPMHS