Pennine Lancashire CAMHS self-referral

Please complete the self-referral form below. All information submitted on this form will be treated with strict confidentiality.

If you have a parent or other adult who can support you to complete the form, 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 it 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.

You can also contact the CAMHS services to see whether there are any opportunities for you to call in to drop in sessions that they may run.

Pennine self-referral

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