The following documents may be requested to gain further information when making a request for support (referral). Completed forms can be attached to your online request.
If you have been sent a paper copy but need a replacement, please download and complete the appropriate documents. All forms are in Word format, just click on the form name in the tables below to download a copy.
We have developed a Guide to Requesting Support for professionals.
Request for support forms - Neurodevelopmental conditions
The following forms are to support requests for potential neurodevelopmental conditions such as:
- Attention Deficit Hyperactivity Disorder (ADHD) – any of its three subtypes Inattentive, Hyperactive and Combined Type
- Autism Spectrum Disorder (ASD), Asperger’s Syndrome, Childhood Disintegrative Disorder, Pervasive Developmental Disorder, Pathological Demand Avoidance (PDA)
Referrals are up from 6 years to 17 years and 6 months and are to be coordinated by the school. For those older than this, GPs need to refer to adult services.
Neurodevelopmental Screening Pack
Please only complete these forms when directed by ND Spoke. These forms may need to be edited through service improvements. Old versions will not be accepted. Once completed, these need to be sent to our ND Spoke team at NDSpoke@sabp.nhs.uk.
Read here for an: Update on the Neurodevelopmental Diagnostic Assessment Pathway for children:: Mindworks Surrey (mindworks-surrey.org).
We recommend using the Neurodevelopmental resource and information page on our website which has lots of useful interventions and resources to assist you during this time.
Please read the guide to completing the Assessment of Need form.
| Form name | To be completed by... |
|---|---|
| Client Demographic Form | Parent/guardian |
| Assessment of Need Form | Parent/guardian and School |
| My Safety Plan | Child/young person |
| Young Person's View Form | Young person 12+ |
ADHD
These forms should only be completed if advised by the ND team. Once completed, these need to be sent to our ND Referrals team at NeuroDevWorkRequests@sabp.nhs.uk.
| Form name | To be completed by... |
|---|---|
| Parent SNAP and additional information. | Parent/guardian |
| School SNAP and additional information. | School, parent/guardian |
| PADH form. | Parent/guardian |
| School Information Form. | Only complete if requested by the Spoke ND team |
Autism
These forms should only be completed if advised by the ND team. Once completed, these need to be sent to our ND Referrals team at NeuroDevWorkRequests@sabp.nhs.uk.
| Form name | To be completed by... |
|---|---|
| PADH form | Parent/guardian |
| School Information form | Only complete if requested by the Spoke ND team |
| Autism Spectrum Quotient (AQ) form. |
Young person if aged 14 or over. Only complete this form if the Neurodevelopmental Team has been in touch with you to request it. |
This form should be completed if advised by NAS. Once completed, this needs to be sent to surrey.familysupport@nas.org.uk
| Form name | To be completed by... |
|---|---|
| NAS Self-referral form | Parent/guardian attending the NAS parenting group |
Assessment forms for ADHD and Autism
These forms should only be completed if advised by the ND team. Once completed, these need to be sent to our ND Referrals team at NeuroDevWorkRequests@sabp.nhs.uk.
| Form name | To be completed by... |
|---|---|
| PADH form | Parent/guardian |
| School Information form | Only complete if requested by the Spoke ND team |
| Parent SNAP and additional information | Parent/guardian |
| School SNAP | School, parent/guardian |
| Autism Spectrum Quotient (AQ) form. |
Young person if aged 14 or over. Only complete this form if the Neurodevelopmental Team has been in touch with you to request it. |
Post diagnosis - ADHD forms
These forms should only be completed if advised by the ND team.
| Form name | To be completed by... |
|---|---|
| ADHD Medication Review |
Requester. Only complete this form if the Neurodevelopmental Team has been in touch with you to request it. |
Requests for support forms - Learning Disability service
| Form name | To be completed by... |
|---|---|
| School Questionnaire - LD | School |