Inclusion Surgery Referral

Be prepared

You need to be prepared before you start this form because:

• you cannot save the form and come back to it later
• if you’re on a page in the form for more than 30 minutes, we’ll reset the form and delete the information you’ve entered

This is to keep the information secure.

What we’ll ask you

We’ll ask about:

• The child, including:
  • any SEND or diagnoses
  • ACEs and safeguarding concerns
  • attendance, including reduced timetables and suspensions
  • academic levels
    
    

• The support that has been in place to date, including:
  
  • the impact of support received
  • whether you have brought the child to the inclusion surgery before, including any actions previously agreed
    
    
• The reasons for your referral, with a focus on why things are not working currently
  
  
• The desired outcomes to help the child progress and ensure advice and support is targeted to their needs