Referral Form NSCHT

Terms & Conditions for NSCHT

• The NSCHT contribution must be paid within 30 days of invoice.
• All assessments and workshops must be booked and attended within a 12 month period.
• Families will need to attend the CICC in Keele, Staffordshire.
• Caudwell Children are unable to provide financial help for travel or accommodation.
• If no contact is made within 2 months then any financial contribution from Caudwell Children may be reallocated for use by another child.

Cancellations and Refunds

• Cancellation of appointments and workshop attendance must be given with a minimum of 48 hours’ notice. We will make every attempt to offer you an alternative appointment at a mutually convenient time and within a reasonable timeframe.
• Failure to attend an appointment without notification will result in referral back to NSCHT unless under the most exceptional circumstances. You will not be offered further appointments at Caudwell Children. However, we will consider waiving this condition where there are extenuating circumstances.
• Repeat cancellations or non-attendance may lead to any Caudwell Children funding being withdrawn and referral back to NSCHT.
• Autism Spectrum Disorder assessments and workshop packages are bought as a whole and cannot be itemised. Should you be unable to complete the full package, we will not be able to offer a refund.
• If the outcome of the assessment is that the child does not meet the diagnostic criteria for Autism no further support will be offered by Caudwell Children Autism Service.

Withdrawal of services

• Providing false information in relation to your assessment.
• Abuse of the staff team or other families visiting the service.
• Damage to the environment or property of Caudwell Children.

Please note

Please inform us of any health risks that you we should be aware of.

Terms & Conditions for Caudwell Patients

• All assessments and workshops must be booked and attended within a 12 month period.
• Families will need to attend the CICC in Keele, Staffordshire.
• Caudwell Children are unable to provide financial help for travel or accommodation.
• If you do not respond to Caudwell’s assessment invitation letter within 2 months then the appointment will be offered to another family and you will be referred back to Midlands Partnership NHS Foundation Trust (NSCHT).

Cancellations and Refunds

• Cancellation of appointments and workshop attendance must be given with a minimum of 48 hours’ notice. We will make every attempt to offer you an alternative appointment at a mutually convenient time and within a reasonable timeframe.
• Failure to attend an appointment without notification will result in referral back to NSCHT unless under the most exceptional circumstances. You will not be offered further appointments at Caudwell Children. However, we will consider waiving this condition where there are extenuating circumstances.
• Repeat cancellations or non-attendance may lead to the child/young person being withdrawn from Caudwell Children and referred back to NSCHT.
• The offer from Caudwell Children is a package of assessment and intervention for a 12 month period.
• If the outcome of the assessment is that the child does not meet the diagnostic criteria for Autism no further support will be offered by Caudwell Children Autism Service.

Withdrawal of services

• Providing false information in relation to your assessment.
• Abuse of the staff team or other families visiting the service.
• Damage to the environment or property of Caudwell Children.

Please note

Please inform us of any health risks that you we should be aware of.

We are sorry that at this time you do not fall within Caudwell Children’s criteria.
For further help and advise please visit our charity links section.

Please Note:

We cannot process the referral without your consent. Please tick ALL> boxes above and try again.

If you have any queries about this referral form or would like further information, please contact us prior to sending the referral.

In order to ensure timely response to referral, please ensure that all sections of the referral form are completed prior sending.

The General Data Protection Regulations 2018 gives new guidance on how organisations need to to control and process the information that you share with us.

As a Charity providing practical and emotional support to disabled children across the UK, we need to process your data to pursue our legitimate business interests, for example, to provide our services, to safeguard vulnerable children and adults and for administrative purposes.

If your application is successful, the Charity will securely retain and process the information provided in this form, together with any associated information during the time we provide service for you and afterwards until your child reaches age 26 years in line with General Data Protection Regulations 2018 and Caudwell Children Privacy and Information Policy.

If your application is unsuccessful, all documentation relating to your application (both paper and electronic) will be confidentially destroyed after a period of 6 months.

Application Team

Caudwell Children

Caudwell International Children's Centre

Innovation Way

Keele Science & Innovation Park

Newcastle-under-Lyme

Staffordshire

ST5 5NT

Tel: 0345 300 1348

Email: applications@caudwellchildren.com