Get Child And Adolescent Psychiatry Referral Request Form

Filling out the Child and Adolescent Psychiatry Referral Request Form online is a crucial step in securing the necessary psychiatric evaluation for your child. This guide will provide you with clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the referral request form.

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by providing the patient’s details, including their name and date of birth. Make sure to double-check for accuracy.
3. Complete the family information section. Input details for each parent or guardian, ensuring to designate who the primary contact will be.
4. Fill out the purpose of the visit. Clearly describe your concerns and what you hope to achieve from the appointment.
5. Provide your child's medical history. List any current medications, allergies, hospitalizations, and relevant previous evaluations.
6. Detail your child's educational history. Include any assistance your child may receive at school and any specific educational disabilities.
7. Complete the developmental history section. This includes milestones your child has achieved and any pregnancy or delivery complications.
8. Fill out the family history and social history sections, detailing any relevant information regarding family dynamics and activities.
9. Provide any additional information such as past psychiatric treatment and current healthcare professionals involved with the child’s care.
10. Review all information for accuracy and completeness. Save your changes and prepare to download or print your completed form.

Start filling out the Child and Adolescent Psychiatry Referral Request Form online today.