PAC-UK Referral Form

Please include as much detail as possible on the referral form below. Fields highlighted with a red * symbol are mandatory and must be completed in order for you to submit the form.

At the bottom of the form there is a verification code you must enter before pressing submit (this is an anti-spam measure). The verification code can be any two digits of your choice, for example 12.

Once you have pressed submit, your form will automatically be sent to the PAC-UK Advice Line who will respond at the earliest possible opportunity. A notification message will appear on your screen confirming your referral has been received.

All information processed in relation to your enquiry and/or booking adheres to PAC-UK's Privacy Policy.

Note, failure to provide enough information could result in delays. Please read each question carefully to ensure all contact details provided are correct.

Client /Parent 1
Client /Parent 2 (if applicable)
If different from Client /Parent 1.
Referring Local Authority /Agency
This should include anyone listed as Client /Parent 1, Client /Parent 2, Child 1, Child 2 or Child 3.
Referred child/ren
Name of all other family /household members
Details of referral
Details of current identified need and service requested – please provide as much detail as possible and include any Child-on-Parent-Violence issues if applicable.
Please advise us of any safeguarding issues or investigations. It is important that this information is provided from the outset to enable planning our services.
Please identify any relevant reports such as CPR, PAR, Annexe A, Adoption-Support Assessments, psychological reports, etc. that will be available once the referral is accepted.
Please advise which Services have been accessed, whether any psychological diagnoses were made, and whether any services are currently being accessed; please attach reports using the below \'Reports Upload\' field.
Medical information
School /Nursery
PAC UK has an Independent Education Service which can provide bespoke training to schools, parent/school consultations, transition support, advice line and Guidance on Pupil Premium Plus. Please indicate if you would like to receive this information. This can be posted to you or sent via email.
Contact details of Social Worker for the CHILD (if different)
Invoicing details (if already known at this stage, please provide us with details of the person who will be dealing with this transaction)