EWP parent/carer referral form
If you would like some support for your child for low-level anxiety or low mood, please complete this form which will go to Mr Holmes, who will make a referral to the Education Wellbeing Practitioner service, provided by the Mental Health Support Team from Achieving For Children.
Please note, if your child already has a referral for CAMHS this service would not be appropriate as they can only be open to one mental health team at a time.  Please remember, the EWP is to support low level anxiety and depression. If you would like counselling for your child, please contact your child's Head of Year.
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Email *
Your email address *
Your child's first name *
Your child's last name *
Your child's year group *
What are you seeking support for? Please give a description of what your child is experiencing and how it affects them. What does this look like on a daily basis? Please include as much information as possible. (Please remember, the EWP is to support low level anxiety and depression. If you would like counselling for your child, please contact your child's Head of Year).  *
When did the difficulties begin/ roughly how long have they felt like this? (you don't need to give a precise date - a general answer is fine!) *
Please list any services that are currently supporting your child - e.g. Early Help, counsellor etc. - either now or previously (please indicate timeframe). If not applicable, please leave blank. Please be aware that if your child is already open to CAMHS or has had a Choice appointment, they will not be eligible for this service. 
Do you give consent for me to refer your child to our Education Wellbeing Practitioner? This will involve giving them your contact information - name, address, phone number and email address.   *
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