Children and Families: Make a referral to the Portage Service

Page 1 of 20 (possible) . You are 5% complete.


Please use this form to refer a child to the Portage service

Please try and give as much information as possible.

Without all the relevant information we may not be able to process your request.

Before you start

Please have the required knowledge/information ready before starting the form:

  • The child must have two or more areas of delay in their development
  • Child must be pre foundation stage between 0 to 3 years
  • Full family details/household
  • Name of playgroup and address
  • Name of any services that are currently involved with the child
  • Name of child’s health visitor (if appropriate)
  • Any special needs and relevant past medical history of child and family members