Make a self referral

Making a referral for your child

As a parent or carer, you can contact us directly to refer your child to our early intervention service, Better Start, Better Future. This service is for babies, with or without a diagnosis of cerebral palsy, from birth up until the age of 2 ½, however, to access this service a referral needs to be made by the time your child is 2.

Please complete the form below which will be sent directly to Glenys Evans, our Family Support Coordinator, who will be in touch to arrange an initial consultation for you and your child if appropriate. Alternatively, you can call our centre on 02920 522600 and speak to Glenys who will take your details and ask you about your child.

Self referral

Child Details
DD-MM-YYYY
Parent Details
Child Medical Details
Please provide information such as; gestation age, birth weight, did they require any medical intervention in NICU / PICU / SCBU? did they need ventilation / respiratory support? did they have an MRI scan? do they have seizures? are they fed by NG tube?
Child's Health Team Information
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