Initial Referral Form - Thank you for considering Sense Inclusion. ...

Thank you for considering Sense Inclusion. If you would like to explore support for a child or young person, please complete our short initial referral form below. This will help us understand their needs and consider how we may be able to help. Once reviewed, a member of our team will contact you to discuss the next steps.

This form should take approximately 5 minutes to complete. We only need some basic information at this stage, and any further details can be discussed during our initial assessment process.

Child or young person's name*

Age*

Current School or Setting

Referrer's Name*

Referrer's school or organisation*

Email address*

Type of support requested

Alternative Provision
Occupational Therapy / Sensory support
Therapeutic Support
Parent / Family support
Not sure - please advise

Does the young person have an EHCP?

Yes
No
In progress

What are the main areas of need or reasons for referral? *

What would you like the support to achieve? *

Is there anything else you would like us to know?

Privacy and Data Protection
The information provided will be used by Sense Inclusion C.I.C. to review your initial referral and contact you to discuss the next steps. Any further information required will be collected securely as part of our assessment process.
Please see our Privacy, Data Protection & Information Sharing Policy for further information about how we collect, use, store and protect personal information.

I confirm that I am authorised to make this referral and share the information provided. I understand that Sense Inclusion will use this information to review the referral in accordance with its Privacy, Data Protection & Information Sharing Policy, available on the website.

Yes