Forms for requests for support (referrals)

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.

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 School Consultations

If you are requesting a consultation for a child or young person a consultation can be booked by calling 0300 222 5856, the lines are open Monday- Friday 9am-12.30pm, we ask that SENCOS complete the paperwork for the appointment but any member of staff can call to book the consultation. You can also email the team on: neurodevworkrequests@sabp.nhs.uk and a member of the admin team will get back as soon as possible. You can read the criteria for a consultation on this update, you will also need to provide the below information and complete forms below to: Neurodevworkrequests@sabp.nhs.uk with the child's full name and date of birth in the subject line.

We will need the following information:

• School name
• School email 
• Parent Name & Parent email (school to provide this) 
• Young persons name 
• Young persons date of birth 
• Any risk noted to self/others/from others

Please can school and parents also collaboratively complete the forms under the heading Neurodevelopmental Screening Pack below:

• Client Demographic Form
• Assessment of Need Form
• My Safety Plan
• Young person view form (age 12+)
• Autism Spectrum Quotient (AQ) form (14+)

In addition, please could you complete the following screening questionnaires, which will be sent out on different links via the email addresses provided to us these will include Parent and School Conners Questionnaires, and Parent SCQ (Social Communication Questionnaire). Please also check your junk folder. 

Once ALL the forms and questionnaires are submitted you will be booked into a consultation. It is important that all documentation is completed, so please check with parents that they have completed the screening questionnaires sent directly to them. If you need any further information you can call our team on: 0300 222 5856, the lines are open Monday- Friday 9am-12.30pm. 

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.

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.

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.

This form should be completed if advised by NAS. Once completed, this needs to be sent to surrey.familysupport@nas.org.uk 

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.

Post diagnosis - ADHD forms

These forms should only be completed if advised by the ND team. 

Requests for support forms - Learning Disability service