The following page details helpful forms that parents and schools may wish to access. Including:
- Forms that schools and parents need to fill out to request an ND consultation (i.e. to make a referral to the CYPS ND Service).
- Forms which may be requested for schools/parents to fill out during the assessment process (you do not need to complete these forms unless advised by a member of the CYPS ND Service).
- Forms you can download in order to request support via our partner agencies or other Mindworks services.
Forms you need to complete when making a request for support to the ND Service for an assessment
The ND Service assess for the following conditions:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Autism Spectrum Disorder (ASD)
Request for support can be made by a school for children that are over 6 years old and up to 17 years and 6 months. For those older than 17 years and 6 months, GPs need to refer to adult services.
Neurodevelopmental School Consultations
The only way to access an assessment with the ND Service is to make a referral via the school consultation route.
Step One:
The first step is for school and parents (and the young person where appropriate) to collaboratively complete the following forms.
- Client Demographic Form - To be completed by parent/guardian
- Assessment of Need Form - To be completed collaboratively by parent/guardian and school SENCO
- Please read the guide to completing the Assessment of Need Form
- Young person view form (age 12+) - To be completed by the young person, if they are 12 years and over
- Autism Spectrum Quotient (AQ) form (14+) - To be completed by the young person, if they are 14 years and over
- My Safety Plan - To be completed by the young person
Step Two:
Once all the above forms have been completed, a member of school staff (e.g. SENCO, class teacher) needs to email the forms to: ndspoke@sabp.nhs.uk. Please use the child’s full name and date of birth as the subject line.
All the above forms need to be included in the same email (i.e. parents and school staff should not send separate emails). We also ask that you provide the below information in your email:
- School name
- School email (for specific member of staff to liaise with)
- Parent name & parent email (school to provide this)
- Young person’s name
- Young person's date of birth
- Any risk noted to self/others/from others
*Please note, that emails with missing information, or missing documents, may not be processed and there will be a delay in accessing the service.
Step Three:
Once the ND Service have processed your email, school staff and parent/guardian will be sent email links (via the email addresses you have provided) to complete further online screening questionnaires. This includes:
- Conners 4 questionnaire sent to school staff
- Conners 4 questionnaire and Social Communication Questionnaire (SCQ) sent to parent/guardian
Step Four:
Once all three questionnaires have been completed online (and submitted via the online portals), the school can request a consultation by calling either 0300 222 5856, the lines are open Monday- Friday 9:30 am- 1 pm, or emailing ndspoke@sabp.nhs.uk. Any member of school staff can contact our team to book the consultation.
*Please check that parents have completed their online questionnaires before calling to book the consultation.
Additional Forms that might be required during the consultation
During the consultation or assessment process, there may be some additional forms that the ND Service requests are completed. Please only complete the below forms if you are specifically asked to do this. All forms are in Word document format, just click on the form name below to download a copy.
- PADH form - To be completed by parent/guardian
- School information form - To be completed by the school
- Update to the Assessment Of Needs form - To be completed by parent/guardian
- Parent SNAP form - To be completed by parent/guardian
- School SNAP form - To be completed by the school
Other useful forms to request support
ADHD - support from Barnardo's
The form below should be completed if a parent or carer wishes to attend the Barnardo’s Surrey Positive Parenting 8-week online or in-person upskilling programme. This programme is for parents/carers with a young person who is diagnosed with ADHD, their young person is on the pathway to being assessed for ADHD, or the family/school are seeing traits of ADHD behaviours.
Once completed this needs to be sent to surreypositiveparenting@barnardos.org.uk. If you can send this as a password-protected document or send the email encrypted this would be the best method. If you would like support with this, email surreypositiveparenting@barnardos.org.uk asking for support before sending us your completed form and we will happily assist you.
| Form name | To be completed by... |
|---|---|
| Surrey Positive Parenting Self-referral form | Parent/guardian attending the Barnardo's parenting group |
ADHD - Post diagnosis ADHD medication
These forms should only be completed if advised by the ND team.
| Form name | To be completed by... |
|---|---|
| ADHD Medication Review |
GP Only complete this form if the Neurodevelopmental Team has been in touch with you to request it. |
ASD – support from the National Autistic Society (NAS)
This form should be completed if advised by NAS. Once completed, this needs to be sent to surrey.familysupport@nas.org.uk
| Form name | To be completed by... |
|---|---|
| NAS Self-referral form | Parent/guardian attending the NAS parenting group |
Requests for support forms - Learning Disability service
| Form name | To be completed by... |
|---|---|
| School Questionnaire - LD | School |