Firstly, we want to thank our patients for their understanding and support as we have worked through our ongoing IT incident. Our staff have worked hard to maintain our services, and to provide care to our communities. We appreciate that the IT outage has resulted in delays and some disruption over the past week, and want to thank everyone involved.

Our focus has understandably been on continued safe and effective care, while NHS England oversaw a thorough and in-depth specialist investigation. This investigation has taken some time but we're pleased that following deep-dive research, there has been no evidence of unauthorised access to patient data.

As a result, we are now gradually and carefully reconnecting some of our priority patient systems, meaning that you should begin to see things return to normal. This will not be immediate and will not apply to all systems at present, so please bear with us as we adjust and reset.

For now, this continues to mean:

• If you are coming to us for a blood test, please make sure you have a paper form. If you do not have a paper form, we cannot do your blood test.
• Unless you are told otherwise, booked appointments are still going ahead as planned.
• If you are due a booked home visit and this has not happened, please call us on 0300 123 3444.

Our staff are working hard to get us back to normal safely and efficiently. Please bear with us, and be kind.

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Parent referral form

This form is intended for use by parents only. If you are a professional referring a child in please use the Referral form –professional

Young persons details

First name *Required

Surname *Required

Date of birth *Required

Date / Date of birth

Address *Required

Address 1

Address 2

City

State/Province

Country

Postal Code

School *Required

Year group *Required

GP's name: *Required

GP's address *Required

Parent/Guardian details

Name *Required

Relationship to child/young person *Required

Your address, if different from child

Phone number: (we require a phone number to call you to discuss the referral. Without this we will not be able to support you with your concern). *Required

Email address: *Required

Do you consent to us contacting you by: *Required

Phone

Text

Is there a social worker supporting the family? *Required

Yes (please provide details below)

Additional information including social workers name and reason for involvement:

Are there any other professionals involved with your child? *Required

Yes (please provide details)

Please provide details:

Is this child or young person a young carer? *Required

Is there an Education Health Care Plan (EHCP) in place? *Required

What are your worries or concerns regarding your child? *Required

How long have these issues been affecting your child? *Required

How does this affect their life? *Required

Is there anything you have already tried to help your child? *Required

What would you like to achieve from this referral? *Required

Is there any additional information you would like to share?

Information Sharing Agreement

Referrals cannot be made without the agreement of you and/or the child/young person.
If we have reason to believe your child or another person is at risk of harm, we have a duty of care to act; this may include communicating with social care.
I agree to information being shared and discussed between professionals and other agencies to help me/my child/young person and family. I understand I will be consulted following these discussions regarding any future planning and actions. I understand I can withdraw my consent at any time.

Do you agree with the statements above? *Required

Yes

Is your child aware of this referral? *Required

Yes

I agree to the privacy policy