Referral forms
Filling in the forms
Watch this video about filling in the forms.
Or you can listen instead.
We would prefer that you fill out the form on a computer. You will need Microsoft Word. (If you don’t have Microsoft Word you can print the form out and fill it in by hand. Please use this print-friendly version of the form)
Tips for filling in the form on your computer
You will find it much easier to fill the form in on a laptop or desktop computer than on a mobile or tablet. Save the downloaded Word document to an area on your computer where you will be able to find it later.
Typing in your answers:
- Where you see ‘Type your response here.’ text highlighted in yellow on the very first box, you need to double click to type over the text.
- When you’ve typed in your answer, you can use the Tab key to keep moving through the answers. Or you can use your mouse and double click in the next answer box.
- Once you tab to the next field, you can type straight over the highlighted ‘Type your response here’ text.
To check a box (for yes/no type questions):
- Click on an answer box with your mouse to add a cross to a box.
- You can click on the box again to remove the cross if you made a mistake.
Providing your signature:
- You can just type your name into the relevant box.
Save your changes regularly in Word so you don’t lose them.
If you have any questions about completing this form please call us on 0330 0245 321 or email cfhd.devonspa@nhs.net
Sending the form back to us
We’d prefer that you email the form back to us at cfhd.devonspa@nhs.net.
When you email us, please make sure:
- the documents you send are only in Word (.doc/.docx), PDF (.pdf) or JPEG (.jpeg/.jpg) formats
- each document is a attached separately and is less than 3MB in size
- you don’t attach multiple single pages
- the email is less than 10MB in total
If this is tricky for you, you can print out the form, fill it in by hand, and post it back to us at: Single point of Access, 1a Capital Court, Sowton Industrial Estate, Exeter EX2 7FW
Which forms do you need?
| What you need help with | Form(s) to print and complete |
|---|---|
| Behaviour | General referral form General form: Download printable version |
| Chronic pain and fatigue | General referral form General form: Download printable version NOTE- Children’s Physiotherapy covers Torbay and South Devon only and requires a referral from a healthcare professional for assessment and intervention. |
| Complex physical health | General referral form General form: Download printable version Additional questions |
| Early years developmental delay | General referral form General form: Download printable version Please complete the general referral form and attach a completed setting questionnaire (if your child attends a setting). To support your referral, we specifically require up to date evidence on your child’s current development. Supporting evidence can come from your child’s nursery/child minder/early years setting by using the observational prompt document attached (setting questionnaire), OR from your Health Visiting Team if your child has received recent support regarding their development. In which case, The Health Visiting Team may be able to provide supporting evidence in the form of an Ages and Stages Questionnaire (ASQ), please ensure the ASQ includes detail around whether the scores fall within the black/grey/white areas. |
| Eating disorder | General referral form General form: Download printable version Additional questions |
| Learning disability | General referral form General form: Download printable version Additional questions |
| Mental health | General referral form General form: Download printable version |
| Mental Health Support Team in Schools (MHST) | Please use the MHST referral form for mild to moderate common mental health difficulties. To confirm whether your school is covered by MHST please visit The Mental Health Support Team in Schools (MHST) – Children and Family Health Devon, or if you have any questions, please feel free to call the Single Point of Access (SPA) on 0330 0245 321. PLEASE ONLY USE THIS FORM IF MHST ARE WORKING IN YOUR CHILDS SCHOOL. If you are unsure if we are working in your/your childs school please check the schools list here: Mental Health Support Team – Children and Family Health Devon If we are not working in your child’s school, please instead refer in using the ‘General referral form’ on the website. |
| Movement | General referral form General form: Download printable version Additional questions NOTE- Children’s Physiotherapy covers Torbay and South Devon only and requires a referral from a healthcare professional for assessment and intervention |
| Neurodiversity | General referral form General form: Download printable version Additional questions – we have not fully mobilised this Pathway yet. Please only use this form if you are requesting an assessment for Autism Spectrum Condition. |
| Physical disability | General referral form General form: Download printable version Additional questions NOTE- Children’s Physiotherapy covers Torbay and South Devon only and requires a referral from a healthcare professional for assessment and intervention |
| Sensory | General referral form General form: Download printable version Additional questions |
| Speech, language and communication | General referral form General form: Download printable version As a supplement to the referral form we would ask that you also complete: *The 2-3 year old language screening toolkit. *The Universally Speaking screener form if you have concerns about language (over 5 years old). *The Speech Sound screener form if you have concerns about speech (we also accept similar screening tools such as Speech Link). Information gathering form (additional information for all Speech, language and communication referrals) If your child has a complex presentation or attends a specialist provision and would like speech and language therapy support please complete the request for help form alongside the screening tools Additional information Complex needs triage communication checklist |
| Swallowing difficulties | General referral form General form: Download printable version Additional questions |
Read about what happens after we’ve received the form(s).