You can download our referral form below. The forms include guidance, please read this before filling in the form.

Please also read the referral and provision criteria documents on our website pages to ensure the referral is appropriate:

Please also check that the client is from within an area we are currently covering (see the service transition page for details).

In some areas referrals are also processed through satellite teams. Specifically:

  • Referrals in Sheffield for AAC for adults should be sent via the NES team
  • Referrals for AAC (all ages) in Leeds should be sent via the Leeds CAS team – 0113 225 3886.

Please contact us if you are unsure about any of the above.


Sending the form

Please email this form to our team address:

If you are sending from another email address this is secure. Alternatively you can send the referral as an encrypted (256bit minimum) document. In all cases, please ensure you are complying with your organisation’s information governance and data protection procedures when sending this form.