Contact us form

We only accept referrals from parents or young people. If you are a professional and would like to recommend us to someone you are working with you can help them to complete this form. Or there are forms that you can download, complete and ask them to sign.

Indicates mandatory fields

SENDIASS - Contact us form

Name of child:

Date of birth

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Do you give consent for the storage of data given?

Nursery / school / college:

Year group:

Name of parent:

Recommended by:

Address:

Parent ethnicity:

Child ethnicity:

Start date:

Telephone number:

Email address:

SEN status:

Diagnosis or area of need