Referral and Consent Forms
Below is a list of different referral forms to access support for children and young people in Doncaster.
Adoption Support
Autism and Social Communication Educations and Training Service (ASCETS)
- Autism Social Communication Education and Training (ASCETs) Consent and Privacy Notice.doc (1)-1
- Download (70KB - DOCX)
Behaviour Outreach Support Service (BOSS)
- B.O.S.S. referral v2024
- Download (91KB - DOCX)
Child and Adolescent Mental Health Service (CAMHS)
- Child and Young Person Mental Health Service (CAMHs or CYPMHs) Referral form
- Download (127KB - DOC)
Community Paediatrics Clinic
- DBTH CPC and 0-5 ASD referral parent and carer v3
- Download (164KB - DOC)
- DBTH CPC Referral Request Form- school or health professional section v2
- Download (132KB - DOCX)
- Request for a Neurodevelopment Health Summary 0-5 years
- Download (208KB - DOCX)
Early Years Inclusion Team (EYIT)
Educational Psychology Service (EPS)
Education, Health and Care Plan Needs Assessment (EHCNA)
- How to refer for an EHCNA
- Download (629KB - PDF)
Go to Doncaster EHC Hub to begin the request
EHCNAEngagement and Behaviour Team
Occupational Therapy and Physiotherapy
Neurodevelopmental Assessment Pathway
Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH)
0-5 Years Autism Pathway
- DBTH CPC and 0-5 ASD referral parent and carer v3
- Download (164KB - DOC)
- DBTH CPC Referral Request Form- school or health professional section v2
- Download (132KB - DOCX)
- Request for a Neurodevelopment Health Summary 0-5 years
- Download (208KB - DOCX)
Service for Children with a Hearing Impairment
- Service for Children with a Hearing Impairment Referral Form
- Download (82KB - DOC)
Hearing Impairment Service
Service for Children with a Visual Impairment
- Consent and Referral Form Master Jan 2025
- Download (92KB - DOC)
Special School Outreach
- Outreach REQUEST FORM May 2024
- Download (25KB - DOCX)
Speech and Language Therapy Service (SALT)
- DBTH Childrens SLT - Request for Involvement
- Download (124KB - DOC)
- DBTH-Childrens-SLT-Feeding-Request-for-Involvement
- Download (1.21MB - DOC)
- Speech and Language Therapy Communication Checklist - age 0-5
- Download (933KB - DOCX)
- Speech and Language Therapy Communication Checklist - age 5-18
- Download (1.24MB - DOCX)
- Speech and Language Therapy - Will the child be seen in school or clinic?
- Download (59KB - DOCX)
South Yorkshire Talking Together
- Talking-Together-Assessment-Form-V2
- Download (131KB - DOCX)
- Talking-Together-Referral-Form
- Download (114KB - DOCX)
Zone 5 - 19 (Previously School Nursing and Project 3) , With Me in Mind and CAMHS
The referral form tells you how to refer to each service, for WMIM, we will continue with the normal consultation process. This new form will be required to be completed by school and emailed over to Lyndsey Burkinshaw/ senior at least 24 hours prior to the consultation as per previous procedure.
If you want to refer to the school nurse / Zone 5-19 or into CAMHs, then you must complete the same form and send it via the email addresses stated on the form.
- CAMHS School Nursing WMIM amended collated referral form
- Download (31KB - DOCX)
- My Mind - childs voice Consultation form
- Download (266KB - DOCX)
Both forms must be fully completed for the referral to be accepted. Referrals will not be accepted without the My Mind form.
Please ensure you only tick 1 service to refer to (selecting more than one will result in delays).
If a YP is referred to WMIM initially and we feel that another service is more suited to support the YP (ie; the school nurse), then we can direct that same referral form to the relevant service without school having to complete another referral and another form.
However, please ensure that you are making the most appropiate referrals to the correct service, as for example, school coming through WMIM to be referred to the school nurse will take much more time and significantly delay the support for the YP, as opposed to going directly to the appropiate service.
Please see below as a guide for interventions and support provided by each service (this is not an exhausitive list but has been provided to guide initial referrals)
WMIM support with;
Anxiety
OCD
Phobia’s
Low mood
Complex cases are encouraged to be discussed with WMIM, and we can step up to CAMHs / specialist services if or when required. Therefore, please still use WMIM’s consultation processes for such cases.
School Nursing / Zone 5-19;
Friendships
Emotional support
Emotional regulation
Self-esteem / confidence
Relationships
For urgent / risk cases
A referral to CAMHs / CAMHs crisis team is required on 01302 796191 or 0800 804 8999.
Please do not wait for a consultation with WMIM to discuss any YP presenting with risk or urgent cases.
Universal Health Services
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