Cerebral palsy - refer your child for treatment

Making a referral for your child (age 2 1/2 or under)

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 1/2, however, to access this service a referral needs to be made.

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

Consent for storing submitted data *

Yes, I give permission to store and process my data

First name of child *

Last name of child *

Date of birth *

Gender *

Male
Female

Address Line 1 *

Address Line 2

City *

Postcode *

Has the child been given a diagnosis?

Yes
No

Child Medical Details

Why are you making a referral to the Better Start, Better Future service? *

Please give us an overview of the child’s birth history *

Does the child have any other medical problem they are being treated for? *

Please list any current medication the child is taking *

Please list any equipment that the child has for use at home *

Make a self referral

Making a referral for your child (age 2 1/2 or under)

Self referral

Therapy and support for children and their families