Pre-school advice request form

This form is for pre-school children only. If your child attends school, referrals must be made by their school.

There are 4 sections to complete:

Consent
Parent or carer details
Child details
Reason for referral

Nurseries, preschools, and childminders are encouraged to send supporting information after the referral is submitted. Please email this to eec.bedsandlutonchildrenshealthhub@nhs.net.

The Speech and Language Therapy (SaLT) Service use the same recording system as many other medical professionals such as your child's GP, hospital staff and other NHS professionals. Please confirm if you agree for those records to be shared. This would mean we can view other health records on your child's file, and other professionals can view our records.

I (parent or carer) consent to the SaLT Sevice sharing the health records with other health professionals (such as their GP and Health Visitor) *

Yes, I give permission

No, I do not give permission

I (parent or carer) consent to the SaLT Sevice viewing information on the health records from other health professionals (such as their GP and Health Visitor) *

Yes, I give permission

No, I do not give permission

I (parent or carer) consent to the SaLT Service sharing information with education professionals (such as pre-school and school staff) *

Yes, I give permission

No, I do not give permission

I (parent or carer) consent to the SaLT Service sharing information with other professionals (such as local authority staff) when needed to support my child *

Yes, I give permission

No, I do not give permission

Have your say

Please tell us about your recent experience with any of our services by answering a few simple questions. We want to hear about what you felt went well and what you think we could do differently.

Your voice makes a difference and helps us improve our services for you and other families.

Pre-school advice request form

Have your say

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