Staff/Teacher Referral for Emotional Support for Students

Staff/Teacher Referral for Emotional Support for Students

If you have any questions, please contact Mrs Gemma Turner, Head of Health & Wellbeing: medical@rossall.org.uk

Date

Referrer

First NameLast Name

Student Name

First NameLast Name

Year Group

Academic/Boarding House

Does the student have any special needs?

Type details here

If you answered yes to the answer above please complete

Have you discussed this with the student and gained their consent for this referral?

Interventions - What has been tried? Please specify - for example, conversation with house parents, signposting to online support

Reason for referral, issue or concerns. You can tick multiple boxes.

If you ticked for 'Behavioural Changes or Other' please give details here

Do you think they would benefit from:

If you ticked 'Other' please give details here

medical@rossall.org.uk