Self Referral & Consent Form

If you would like to contact the Bexley IAS Service for Information or advice as a parent / carer of a child or young person with Special Educational Needs and / or a Disability, please use this secure page to upload your information.

If you are a young person between 16 – 25 years old and would like to contact Bexley IASS directly for advice and information please use this secure form to do so.

Please ensure that you have read and understood the Bexley IASS Impartiality, Confidentiality and Privacy polices before submitting this form

If you are a professional supporting a parent, carer or young person, please ask them to complete our referral and consent form. We are unable to discuss their situation with you until we have had direct contact and written consent from them.

You can either fill the auto referral form below which comes directly into our email in box or if you would prefer, you can down load a paper copy, fill it in and send it off to us: DOWNLOAD PAPER REFERRAL FORM HERE

AUTO FILL REFERRAL FORM:

Name of Parent or Carer (or young person aged 16+ if completing this form themselves)

Address

Telephone Number

Referral Date

How did you hear about the Bexley IASS Service?

I am a (please tick):

Parent/carer Young Person (aged 16-25)

Have you contacted Bexley IASS before? (please tick)

Yes - Existing issue Yes - New issue Yes - about a different child/young person No

Consent to contact professionals (please tick):

No - not required at this stage Yes - by ticking this box, i confirm i am the parent/legal guardian or young person aged 16-25 and that i consent to Bexley IASS contacting relevant professionals to request information and discuss issues regarding my situation/issue.

Child or Young Person's Name

Child or Young Person's Date of Birth

Child or Young Person's Ethnicity

Child or Young Person's Gender

Child or Young Person's Name of nursery / school / college if attended

Child or Young Person's Primary Need

Child or Young Person's Diagnosis (if any)

Current level of support provided by school / college (please tick):

No Special Educational Needs (SEN) Support Special Educational Needs (SEN) Support Education, Health and Care (EHC) Plan Don't know

If your child is on SEN Support level - do you know if they have been discussed by the Early Intervention Team (EIT's) ?

Yes No Don't know

If your child or young person has an EHC Plan - when was their last annual review?

If your child or young person has an EHC Plan - what is the name of their allocated Case Officer?

Are there any other services involved in supporting your child or young person? For example - speech and language, occupational therapy, CAMHS etc

What is the main reason you are contacting Bexley IASS (please tick)?

I don't understand what SEN support should be provided Not enough SEN Support is being provided How to apply for an EHC Needs Assessment I have applied for an EHC Needs Assessment but it has been rejected by Bexley Local Authority The content of my child or young persons EHC Plan EHC Plan annual reviews Mediation and appeals Other (please state below):

'Other' - please state

Please provide further information if required

Self Referral & Consent Form

If you would like to contact the Bexley IAS Service for Information or advice as a parent / carer of a child or young person with Special Educational Needs and / or a Disability, please use this secure page to upload your information.

If you are a young person between 16 – 25 years old and would like to contact Bexley IASS directly for advice and information please use this secure form to do so.

Please ensure that you have read and understood the Bexley IASS Impartiality, Confidentiality and Privacy polices before submitting this form

If you are a professional supporting a parent, carer or young person, please ask them to complete our referral and consent form. We are unable to discuss their situation with you until we have had direct contact and written consent from them.

You can either fill the auto referral form below which comes directly into our email in box or if you would prefer, you can down load a paper copy, fill it in and send it off to us: DOWNLOAD PAPER REFERRAL FORM HERE

AUTO FILL REFERRAL FORM:

If you have documents you would like to upload to Bexley IASS securely, please upload

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