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Sunday 17 February 2019
Derbyshire Healthcare NHS Foundation Trust
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CAMHS Eating Disorders - self-referral form for children and young people
Has this issue been discussed with your GP?  »
We may need to contact your GP for further information to help with your referral. Do you consent to this? »
Do you currently attend school/college? »
Should we need to; do you give consent for us to contact school for further information? »
Are your parents/carers aware that you have contacted our service?
Do you give us permission to contact them?  »
If Yes, please give details:


If you do not consent to your parents being contacted currently, we may need to talk with you further and agree a plan. There may be times we may need to make your parents aware, depending on your age and circumstances. We will not contact them without your knowledge
Please note:

Once we receive your referral a member of the team will contact you on the next working day (Mon-Fri) by telephone. The aim of this will be to discuss your worries further, and decide with you on the appropriate next steps.  If we agree that an assessment with our team would be helpful, we aim to see you within 4 weeks or sooner if needed.  If your referral is not appropriate for our team, we will discuss alternative steps with you.