COTAForm



Please call Liverpool Wheelchair Service on 0151 296 7765







Please contact ADDvanced Solutions on 0151 486 1788 or visit ADDvanced Solution to book a place at an awareness session.

Please leave your details and we can send you information about the Sensory Processing Awareness Sessions and Parent Consultations for children 5 years and under at the Children Centres.

Please leave your details and we can send you information about the Parent Consultations.





For help with handwriting contact the child?s SENCO.

Enter address manually

Consent

Have you been given consent from the parent or those who have parental responsibility to make this referral?

Unless the child is at risk of significant harm, you must speak to their parent or carer to gain consent and make them aware of how we share information. If you fail to get consent or explain why you could not, your referral will be rejected.



We are sorry but as you have not sought parental consent, we cannot process your request.

About the child

Enter address manually

Who else lives at the child?s address?

Other family members


.

About the child?s GP?

Please indicate which areas the child requires support from occupational therapy

When you submit this form using the button below you are agreeing to our privacy notice and terms. Find out how we share information.

Add Document

Please attach any supporting documents eg handwriting samples, school reports, doctor?s letters, EHAT.


Documents

Name Size Progress
{{ item.file.name }} {{ item.file.size/1024/1024|number:2 }} MB

Total uploads have exceeded maximum size of 15 MB.