If you are referring into Children's Physiotherapy, Occupational Therapy or Speech and Language Therapy, please complete the form below.  

Please note, by completing this form, you will be contacted by text, phone and email regarding the child. If you do not wish to be contacted, please inform the service by calling 01522 309025 or emailing LHNT.lincschildrenstherapyservice@nhs.net.

Children’s Therapy Services – request for help

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Required
Address: Required
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By requesting this referral to the LCHS Child Therapy Services the parent/carer gives verbal/written consent to the Child Therapy Service sharing relevant information, including electronic records, with other services or professionals involved with the child. This may include discussing the child’s Therapy needs with their educational setting. 

Do/do not consent to:

Required