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Referral Form

How to complete a referral:

  • All referrals must be completed by a healthcare professional (such as a GP, Consultant, Allied Health Professional or Nurse). Referrals not completed by a healthcare professional will not be accepted and will be returned to the referrer.
  • Please ensure the child or young person meets our acceptance criteria before completing a referral. If you are unsure if the child or young person meets the criteria, please contact us to discuss.
  • Please read the form carefully and fill in as much relevant information as you can.
  • If you have any reports or clinic letters that will provide further information please attach to the referral form.
  • We hope our referral form is easy to complete, however if you have any difficulties please contact us for further advice.
  • Send the completed referral form to the address located at the end of the form.