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Online Referral Form - Parent, Carer & Professional

About this referral

If you require immediate help, please call 999 / attend A&E or contact the Mental Health 24/7 Support Line (0808 196 3779). Further contact details can be found here >

This form is for parents/carers/professionals who want to arrange advice or support for a child/young person (age under 25) with a Nottingham City or Nottinghamshire County GP (excluding Bassetlaw – please use https://nottalone.org.uk/ to identify the local services available in this area).

The service also takes phone referrals: 0115 708 0008

The Be U Notts Service is here to give information, advice and support to children and young people who are struggling with their feelings.

For example, they may:

  • feel sad or hopeless
  • have problems with family, friends or at school
  • hurt themselves or have thoughts about hurting themselves
  • feel anxious and scared
  • struggle with transitions or loss
  • have problems with eating and food
  • have trouble talking or sleeping
  • feel angry or are struggling to control their behaviour or temper
  • find it hard to concentrate or get on with friends
  • have to check or repeat things, or worry about germs
  • do not like themselves or have low self-confidence
  • have other things on their mind that they struggle with.

The Be U Notts Service has also an offer for parents / carers to help them support their child / young person.

We will be in contact with the parent / carer or child / young person as soon as we can after receiving this form to discuss how we can help. 

Who is making this referral?

So we can give you accurate and appropriate advice and support, we sometimes need to share the details you have provided with others such as your GP Practice, school, social work or any other services relevant to the support you and your child / young person might need.

By sending this referral form:

  • you give consent for the Be U Notts Service to share your details with relevant professionals /organisations to give you accurate and appropriate support.

You may withdraw this consent at any time, by writing to the Be U Notts Service Manager and asking for your referral to be cancelled. This will mean you / your child/young person will be discharged from the service and your referral will be closed on our secure patient database.

  • you agree that information provided will be stored on a secure Be U Notts database for a minimum of 2 years and to be used anonymously for monitoring purposes.

If professional:

Child / Young Person's Details:

Contact preferences:

GP Information:

Other Information: