Children’s Speech and Language Therapy Request for Assistance

If you have any queries regarding the completion of this form please contact the Children’s Speech and Language Therapy Service on 0300 421 8937

We are happy to accept requests for assistance from anyone supporting the child. However, informed parental consent must have been given before completing this form.

If this referral is accepted for treatment, the Speech and Language Therapy Service will work with parents/ carers and/ or setting/ education staff to set goals and give advice that will help the child to develop their communication. The child will be discharged from Speech and Language Therapy while they are supported by those around them to reach their goals.

Please note: This referral form takes roughly 30 minutes to complete. You may need to gather additional information before you complete this form, e.g. digital copies of delegation of authority documents (if applicable), EHCP.

Please note: If this form is left unused for more than 120 seconds (2 minutes) it will timeout and you will need to restart. Please ensure you complete the form in one go.