Pennine Lancashire CAMHS self-referral

Please note: these forms are currently being reviewed by young people and future editions may change.

Please complete the self-referral form below.

If you have a parent or other adult who can support you to complete the form then they can help you to fill it in or fill it in for you.

If you are unable to complete the form online you can download a copy, complete and post to: ELCAS Admin Offices, Area 3, Level 3, Burnley General Hospital, Casterton Avenue, Burnley BB10 2PQ or email to

Please phone 01282 804806 if you have any queries, we are available between 9am and 5pm Monday to Friday.

Pennine self-referral

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