CYP Referral Form for Professionals

Children, Young People's, and Families Referral Form - for PROFESSIONALS

We have made the difficult decision to close the waiting list for 1-1 therapy, including music therapy in the Children and Young Person’s Service with effect from 5pm on Friday 6th November 2023. We are still accepting referrals for CYP group support.

You can use the form below to refer children and young people that you are working with for support with their experience of domestic violence and abuse. RISE CYP and Family Service offers support to:

• Children and young people who live in Brighton and Hove.
• Children and young people who have been impacted by some form of domestic violence or abuse in their lives.
• Parents/carers who consent to being contacted by us to discuss their child or young person’s support options in relation to their experience of domestic violence and abuse specifically.

Other organisations

Parent/Carer Details

Parent/Carer Address
Is it safe to (tick all that apply): *
Parent/Carer GP Details

Child or Young Person's Details

CYP Date of Birth
CYP Address (if different from Parent/Carer)
GP Name and Address (if different from Parent/Carer)

Please provide us with some more details about the child or young person being referred:

Sex/Gender

What is your child’s gender assigned at birth?
Do they still identify with that gender?

Sexual Orientation

Disabilities

Does your CYP have any of the following disabilities? (Tick all that apply)

Does your CYP have any of the following accessibility requirements?

Tick all relevant boxes

Mental Health History and Diagnoses

Is your CYP okay communicating in English?
Does your CYP need an interpreter?

Your CYP's Ethnicity

Other organisations

Please tell us the reason for this referral

Current suitability for CYP and Family intervention:

Are there current criminal court proceedings? *
Are there currently any family court proceedings? *

What is the current contact between the CYP and alleged perpetrator?

Do you wish to receive a copy of this referral form to your email inbox? *

Thank you for completing this referral.