Get Sunnybrook Youth Psychiatry Referral Form Revision Jan 5

Filling out the Sunnybrook Youth Psychiatry Referral Form is an essential step for accessing mental health services for youth. This guide will provide you with clear and user-friendly instructions to ensure that you can complete the form accurately and efficiently online.

Follow the steps to complete the form effectively and efficiently.

1. Press the ‘Get Form’ button to access the Sunnybrook Youth Psychiatry Referral Form and open it for your use.
2. Begin by filling out the ‘Physician Referred To’ section by providing the name of the doctor to whom you are referring the youth.
3. Set the ‘Referral Date’ by entering the date in the format DD/MM/YY.
4. In the ‘Youth Demographic Information’ section, enter the youth's surname, given name, date of birth (D.O.B), gender, and age.
5. Complete the contact details by entering the youth's phone number and address. If the address is the same as the parents', indicate this by marking the corresponding option.
6. Fill out the ‘Health Card #’ and ‘VC’ fields as required, and indicate if the youth is involved with the Children’s Aid Society.
7. List any current medications the youth is taking, including dosage and duration — up to six medications can be added.
8. In the ‘Referring Source Information’ section, outline the reason for the referral and provide your name, address, phone number, and the referring professional's title.
9. If applicable, include the billing number in the designated field and proceed to the ‘Parent Demographic Information’ section to fill in the parent's name and address if it differs from the youth's.
10. Document any notes required in the ‘Office Use Only’ section and provide the home and cell phone numbers if necessary.
11. In the ‘Reason for Referral’ section, highlight the primary and any secondary reasons by checking the appropriate boxes.
12. Check any additional areas of concern that may be relevant to the referral.
13. Confirm whether assessment or treatment summaries have been forwarded to the Sunnybrook Youth Office and provide details of family psychiatric history.
14. Once all fields are completed, you may save changes, download, print, or share the form as needed.

Take action today by completing the Sunnybrook Youth Psychiatry Referral Form online.