Due to an ongoing issue with email deliveries, please download this file and fill out in Microsoft Word:
Then email the completed form directly to:
Thank you for your patience, whilst we resolve the problem.
Use to refer to:
- Occupational Therapy
- Speech and Language Therapy
- MOSAIC- Integrated Service for Disabled Children
If the child or young person’s only concern is related to mental health please send a referral letter to Joint Intake Services, Tavistock Clinic, 120 Belsize Lane, London, NW3 5BA, or call them on 020-8938-2638.
How to use this form:
1. Sections 1, 2, and 4 must be completed.
2. You can use this form to refer to one or more services at the same
time. Please tick the child's main
of need in Section 4. This information will be used to make sure the
referral gets to the right team
3. Complete all other relevant sections to the child's needs. You do not
need to complete every
section. Please provide detail about why you are referring. This detail
helps us ensure children receive
right treatment or intervention as quickly as possible.
4. Please attach any relevant documentation (e.g. reports, letters) when
prompted at the end of the online form.
Items marked with a red asterisk (*) must be completed.
If you have any problems completing the form please contact adminSPOR.firstname.lastname@example.org