Berkshire Sensory Consortium School Age Referral Form
Referral form for Berkshire Sensory Consortium Service
Sign in to Google to save your progress. Learn more
Email *
This form is to be completed by Education and Health Professionals only
Please note, referrals can only be accepted if the following requirements have been met:
1. Pupil has an identified, diagnosed hearing and/or visual impairment and/or evidence of protracted history of middle ear complications
2. Evidence from health colleagues is available to support the diagnosis and/or history
3. Parents have been consulted and have consented to this referral    A signed consent form will be sent in addition to this referral.
4. School staff have specific and identified concerns based on observation/collected evidence/issue of aids/or hospital alert.


Upon receipt of the referral we will:
1.Respond with an initial contact within 5 working days.  Our referral process can be found on our website: https://www.berkshiresensoryconsortium.co.uk/referral-process/

The assessment service is centrally funded for all Local Authority schools and pre-schoolers within the Education Authorities who make up the Sensory Consortium:
Bracknell Forest Borough Council
Reading Borough Council
Royal Borough Windsor and Maidenhead
Slough Borough Council
West Berkshire Council
Wokingham Borough Council.

In the case of non-maintained or independent schools and organisations, the service is subject to a charge of £110.00 (+ VAT) per visit inclusive of travel and administrative elements. A booking requires completion and return of a directly purchased input form.

If you have any questions about this form, please email sensory.consortium@achievingforchildren.org.uk or telephone 01628 796786.

Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of RBK, LBS and AfC (unifiedgov.co.uk). Report Abuse