Section 1/3: GP and Patient Information
This form collects only essential data for a safe referral, in line with NICE Guidelines CG128/NG87 (1.2 & 1.3).
Before proceeding, please ensure you have reviewed the exclusion criteria and pathway descriptions on the previous page. It is the responsibility of the GP to obtain informed consent for this referral from the child and parent/guardian, where required.
Important Restrictions:
- NHS Right to Choose: Only available via NHS GPs in England.
- Norfolk & Waveney ICB: Do not use this online form for Autism referrals. Please use the local N&W template within your GP clinical system
This form collects only essential data for a safe referral, in line with NICE Guidelines CG128/NG87 (1.2 & 1.3).
Before proceeding, please ensure you have reviewed the exclusion criteria and pathway descriptions on the previous page. It is the responsibility of the GP to obtain informed consent for this referral from the child and parent/guardian, where required.
Important Restrictions:
- NHS Right to Choose: Only available via NHS GPs in England.
- Norfolk & Waveney ICB: Do not use this online form for Autism referrals. Please use the local N&W template within your GP clinical system
