Refer your child.

Who is making this referral? *

Your name *

Your email address *

We use this to contact you about the referral, and this is where we send the consent form for you to sign. Please check it carefully.

Confirm your email address *

Please type it again rather than pasting, so a mistake shows up now.

Your child's name *

Your child's date of birth *

You need to be 16 or over to refer yourself. If you are under 16, please ask a parent or carer to complete this form.

Your child's school or setting

Optional. If they are home educated, on an EOTAS package or not currently in a setting, tick the box below instead.

Your child's year group

Optional. Leave blank if it does not apply.

Name of the SENDCo or contact at the setting *

Their email address *

We contact them to agree a date for the visit — we do not share the reason for your referral with them. Not needed if you ticked “not currently in a school or setting” above.

Reason for referral *

A short summary of your concerns is enough — we will go through things properly with you. Please do not include anything you would not want held in a clinical record.

Supporting documents (optional)

Optional — for example school reports, letters or previous assessments. Up to 10 files / 50 MB total. PDF, DOC, DOCX, JPG or PNG.