CAMHS Youth Team Screening Questionnaire

Note: Questions marked by * are mandatory

*This is a mandatory field. Name

*This is a mandatory field. Date of Birth

*This is a mandatory field. Contact number:

*This is a mandatory field. Email address:

*This is a mandatory field. Please tick if you consent to receiving communication via:

Phone
Email
SMS/Text

*This is a mandatory field. Do you have any information communication support needs?

Please provide details:

*This is a mandatory field. Would you like support from a youth worker?

*This is a mandatory field. If there are any specific areas you would like support with?

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