Trafford Sleep Services 1:1 Clinic Referal Contact Details Professional details Parent/Carer details Child details Child Date of Birth Does the Child have any additional needs? ADHDASDBehaviour DisorderDown SyndromeEpilepsyGlobal Developmental DelayHearing LossHypermobilityModerate Learning DifficultyPathwayPhysicalDisabilityProfound and Multiple Learning DifficultySelective MutismSocial, Emotional and Mental Health DifficultySpecific Learning DifficultySpeech, Language and CommunicationTourettesVisual ImpairmentNone Type of sleep difficulty Settling to sleepNight wakingBed wetting (after the age of 5)Sleep TerrorsNightmaresEarly morning wakingNone Does this child have an EHCP YesNo I confirm this referral has been discussed with parents I confirm I have advised parent that they need to attend a webinar before their 1:1 appointment. I confirm this child will be actively supported by our service Contact us Get in touch Working together to transform children’s lives through Sleep and Therapy Services Email Address Trafford@sleepandtherapyservices.co.uk Email Phone number +44 7838110985 (Please get in touch by email as we are not always contactable by phone) Phone
