PATSS (Plymouth Advisory Team for Sensory Support) Please complete as much of the form as you can, ensuring that you have the signed consent of the young person’s parent or carer to share information, as this referral may be considered at a Children’s Integrated Disability Service SEND meeting. Please return to: Advisory Team for Sensory Support, Windsor House, Tavistock Road, Plymouth PL6 5UF Tel: 01752 668000 Text/SMS 07500 122724 or email Parent and child details Child's name DOB Parent or carer name DOB Address Home phone Mobile phone Ethnicity First language Hospital number Email address Referrer details Referrer's name Designation Phone number School details School UPN Year Is a SEND Plan? Yes No Has this student seen GP or school nurse regarding their hearing/vision? Yes No Other services involved with this young person Name Contact Name Contact Name Contact Name Contact
PATSS (Plymouth Advisory Team for Sensory Support) Please complete as much of the form as you can, ensuring that you have the signed consent of the young person’s parent or carer to share information, as this referral may be considered at a Children’s Integrated Disability Service SEND meeting. Please return to: Advisory Team for Sensory Support, Windsor House, Tavistock Road, Plymouth PL6 5UF Tel: 01752 668000 Text/SMS 07500 122724 or email Parent and child details Child's name DOB Parent or carer name DOB Address Home phone Mobile phone Ethnicity First language Hospital number Email address Referrer details Referrer's name Designation Phone number School details School UPN Year Is a SEND Plan? Yes No Has this student seen GP or school nurse regarding their hearing/vision? Yes No Other services involved with this young person Name Contact Name Contact Name Contact Name Contact
patss_-_request_for_involvement.docx