Children's Services

Inter-Agency Referral Form

This form is to be used when making a referral to Children's Social Work Services, Early Help Support or Youth Offending Service.


Before making a request for support through this referral have you:

  • Discussed your concerns with the child and family (unless to do would place the child at risk of harm) and gained their consent? (Read more about information sharing).
  • Considered the threshold guidance and thought about whether you are making a referral to the right service for the right reasons?
Remember: In making this referral you are not passing the case on, but are asking us to join you in your work.
Please do not use the following special characters in any text: { } [ ] < > *
Please do not include any profanities and/or swearing in your form as this may result in it being blocked.
* Denotes a mandatory field.
Consent and Information Sharing
Referrer Details
A confirmation email will be sent to this email address.
It is expected that a referrer is available to clarify and discuss the information contained in this referral for 72 hours. Please ensure a colleague is aware of this information in your absence.
Children in household
EditChild's NameDOB/EDDNHS NumberDelete
No details exist.
Who else lives with the child(ren)?
No details exist.
Other people who don't live with the child(ren) but are significant
No details exist.
Professionals involved with the child(ren) and family
No details exist.
Please attach details of any other plans in the uploads section at the bottom of this form.
Outline individual factors e.g. culture/lifestyle, learning styles, maturity, finances, time keeping, communication needs, education commitments, caring responsibilities, learning and physical disabilities etc.
Primary Concern
*Please identify your primary concern:
Clicking on an option will present you with further appropriate questions.

Referral Type
Submit Form
Upload documents
To attach a document to this form, drag and drop it to the area below, or click the 'Upload file' button. To remove the attachment, click the icon.
A maximum of 5 files can be uploaded, of the following type: jpeg, jpg, gif, png, bmp, doc, docx, pdf, txt, xlsx