This Youth Therapy Referral Form is designed to gather essential information for a young person seeking therapy. It includes details about the client's personal information, presenting issues, mental health history, and the reason for the referral. The form also allows for emergency contact details and additional background information to assist the therapist in providing appropriate care. This form is typically completed by the referring individual, such as a parent, guardian, or school counselor, and submitted to initiate the therapy process.