Forms to download and complete

Different forms need to be completed depending on the age of the child requiring assessment.

Please ensure the referrer or keyworker has known the child/young person for at least 3 months prior to referral, otherwise the referral may not be accepted. Working with the child/young person for a minimum of three months will ensure you are able to provide sufficient information for the referral.

Under fives

  1. Single Point of Access referral form - this form also has links to the questionnaires below, which also need to be completed.
  2. Parent/carer questionnaire 
  3. Teacher questionnaire - nursery/primary school questionnaire - if in a nursery or school setting. 

Primary aged children

  1. Single Point of Access referral form - this form also has links to the questionnaires below, which also need to be completed.
  2. Parent/carer questionnaire 
  3. Teacher questionnaire - nursery/primary school questionnaire - if in a nursery or school setting
  4. Vanderbilt questionnaire - parents 
  5. Vanderbilt questionnaire - teacher

Secondary aged children

  1. Single Point of Access referral form - this form also has links to the questionnaires below, which also need to be completed.
  2. Parent/carer questionnaire 
  3. Teacher questionnaire - secondary school
  4. Vanderbilt questionnaire - parents 
  5. Vanderbilt questionnaire - teacher

Returning the completed forms

The completed forms to be sent to:

Email: dhcft.SPOA@nhs.net

If you need to discuss a new or existing referral, the SPOA Administrator can be contacted on 0300 7900 264.