I have had the reasons for information sharing explained to me. I understand reasons and that I can withdraw consent at any time. I agree to the information sharing as noted above Yes I do not give my consent at this time to share information with the services listed below. No (You may be contacted to discuss this further) Parent’s Signature (Please note certain services require this to be completed and failure to do so may a delay) Signed Name Date Requestor’s Signature Signed Name Date Please forward to the Early Support Programme Officer in your area Email (via a secure system): NORTH SOUTH CENTRAL Early Support Programme Officer Early Support Programme Officer Early Support Programme Officer Samuelson House Oxfordshire County Council The Wheatley Centre Tramway Road Abbey House Littleworth Road Banbury OX16 5AU Abbey Close Wheatley OX33 1PH Abingdon OX14 3JD Tel: 01865 816656 Tel: 01865 323555 Tel: 01865 812629 Fax: 0845 6054189 Fax: 01865 783329 Fax: 783340 Where to go for help and advice SLT OT Physio Therapists are also available for phone conversations prior to making a request. EY SEN The team will only be able to become involved if appropriate when a child has also been – referred to the Community Paediatric service. Settings can contact their link health visitor who will be able to advise. If you need information around a particular child then you will need to have parental consent. The Early Support Programme Officers will still be available to help and advise you. Access to a name” consultation for the EYSEN team is still available. Please call either “no 01865 323556 or 01865 812628 The EYSEN toolkit continues to offer you help in the identification and support of children with SEN. SENSS
I have had the reasons for information sharing explained to me. I understand reasons and that I can withdraw consent at any time. I agree to the information sharing as noted above Yes I do not give my consent at this time to share information with the services listed below. (You may be contacted to discuss this further) No Parent’s Signature (Please note certain services require this to be completed and failure to do so may a delay) Signed Name Date Requestor’s Signature Signed Name Date Please forward to the Early Support Programme Officer in your area Email (via a secure system): NORTH Early Support Programme Officer Samuelson House Tramway Road Banbury OX16 5AU Tel: 01865 816656 Fax: 0845 6054189 SOUTH Early Support Programme Officer Oxfordshire County Council Abbey House Abbey Close Abingdon OX14 3JD Tel: 01865 323555 Fax: 01865 783329 CENTRAL Early Support Programme Officer The Wheatley Centre Littleworth Road Wheatley OX33 1PH Tel: 01865 812629 Fax: 783340 Where to go for help and advice SLT OT Physio Therapists are also available for phone conversations prior to making a request. EY SEN – The team will only be able to become involved if appropriate when a child has also been referred to the Community Paediatric service. Settings can contact their link health visitor who will be able to advise. If you need information around a particular child then you will need to have parental consent. The Early Support Programme Officers will still be available to help and advise you. Access to a “no name” consultation for the EYSEN team is still available. Please call either 01865 323556 or 01865 812628 The EYSEN toolkit continues to offer you help in the identification and support of children with SEN. SENSS
updated-SPORFI-form-10.17.docx