Parent & Carer Referral

Please respond to the following questions to the best of your knowledge.

Only the questions marked with * are mandatory but the more information you can provide us, the more effectively we will be able to help you.

After you submit your form, a member of our team will contact you the next working day. 

If you do not hear from us on the next working day after you have submitted your form, please give us a ring on 0203 228 2545. 

Alternatively, if you do not want to submit an online form you can also make a referral by calling us on 0203 228 2545 between 9am and 6pm, Monday to Friday. You will be put straight through to a clinician who will go through the questions that are on the online form with you.

We need some information about the young person you would like to refer:
If you don’t know your GP’s postcode, the NHS GP finder finder is an easy way to get it.
We will not be contacting the school without checking their consent first.
Can you tell us a bit more about the problem...















Finally we'd like to know how to get in touch with you...
We need this in order to contact you about your referral:
An email address would also be useful if you have one in case we need to send you any information:

What will happen next?

Once submitted, this form will be sent securely to our team. It will be screened by a clinician within one working day. We will contact you to discuss the information you have given us and give you a possible date for an assessment in our service. Click Here to view our Terms and Conditions