IThrive 2 – 19 years Referral Form

1. Details of the Person being Referred

Please use a space e.g EC11 7YU

2. Parent / Carer Contact Details

3. Nature of Referral

Reason for referral If possible, include the intended outcomes of the referral and the service you think will best support the child/family.
Include if under a child protection plan or whether Looked After.
Please tick the relevant boxes below to enable us to access the most appropriate service for the child as quicky as possible.
Specify here if you answered 'other' to the previous question or type none.

4. Details of the Referrer

Consent is given to share information with Bolton Together and wider agencies offering support for EHWB. Consent must be given before referring.
We support the IThrive approach to our work putting the child/young person (CYP) at the centre of the approach and empowering and supporting them to make changes for themselves. The most effective way of doing this is for the child/young person to understand what support they are accessing and to have agreed to participate in this support. Before referral please ensure that a conversation has taken place with the CYP about our services and that they have agreed to being referred. Please tick this box to confirm that this has taken place. * n/a to the early years provision

The IThrive Programme is supported by NHS Bolton Clinical Commissioning Group, NHS Bolton Foundation Trust, and The National Lottery Community Fund.

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