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Referral on someone's behalf

If you are referring through an education setting, organisation or as a professional then please complete the following form with as much information as possible and we will be in touch. The more information you provide, the better.

Important: Please do not disclose the name or any information which could identify the child or young person at this stage unless you have parental consent to share this information with us.

Your name: *
Role: *
Your email: *
Your phone number: *
Name of education setting or organisation: *
Address of education setting or organisation:
Age of child/young person: *
What are the main concerns regarding the child/young person? *
What do you want from our involvement? *
Does the child or young person have any existing diagnoses?
Please feel free to attach any relevant documentation or reports with this referral. If there is more than one document please attach as a zip file.

No file selected.

Please select any professionals who have been involved with the child or young person:

Thank you!