Make a Referral

Step 1 of 12
Both parents and professionals can make a Referral using this form which must be completed in full. All details will be dealt with in strict confidence unless authorised to release, or in the event of safeguarding issues involving children or vulnerable adults. Please note there is a registration fee of £50 which includes a pre-assessment at the Centre.

1. Children

If there is more than one child in your application, please enter them in the box above (one per line) including their date of birth.
If yes, please give details below.