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)
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.
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+ |
Autism Spectrum Quotient (AQ) form. | Young person 14+ |
Follow on Assessment of Need form | Only to be completed when instructed to by a professional |
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 |
The form below should be completed if a parent or carer wishes to attend the Barnardo’s Surrey Positive Parenting 8-week online or in-person upskilling programme. This programme is for parents/carers with a young person who is diagnosed with ADHD, their young person is on the pathway to being assessed for ADHD, or the family/school are seeing traits of ADHD behaviours.
Once completed this needs to be sent to surreypositiveparenting@barnardos.org.uk. If you can send this as a password-protected document or send the email encrypted this would be the best method. If you would like support with this, email surreypositiveparenting@barnardos.org.uk asking for support before sending us your completed form and we will happily assist you.
Form name | To be completed by... |
---|---|
Surrey Positive Parenting Self-referral form | Parent/guardian attending the Barnardo's parenting group |
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 |