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Home » Referral » Professionals Referral Form

Referral to City Family

Please enter the details on behalf of a family you are working with.

Parents/carers can connect with our Navigators, who offer information and guidance on resources for families with younger children. They’re also here to listen and support on days that feel tough and, and if needed, can arrange for a family or children’s practitioner to support in navigating many different aspects of family life, child development and parenting, including before your baby is born. If English is not you first language, we can arrange translation services

Referral Form for Professionals NEW

"*" indicates required fields

please enter details here
Has consent been obtained from the parent/carer for this referral to be made?*
DD slash MM slash YYYY

Parent/Carer Details

Please enter the details for Parent/Carer 1 here
DD slash MM slash YYYY
Gender of Parent/Carer 1*
Address of Parent/Carer 1*
Status to Child(ren)*

Does the child reside with this person?*

Please enter Details for Parent/Carer 2 (if applicable)

Please enter the details for Parent/Carer 2 here
DD slash MM slash YYYY
Gender of Parent/Carer 2
Address of Parent/Carer 2
Status to Child(ren)

Does the child reside with this person?

Child(ren)'s Details

Please enter the details of the child(ren) here
If the child is unborn, please check this box
DD slash MM slash YYYY
Gender of Child
Please select from list below

Is the child currently known to Children's Services?
Presenting need or reason for referral
Are there other agencies/ professionals supporting with this element

Additional Considerations and Information

please add any further details here
Is there currently domestic abuse taking place in the home?
Is the family:
(including but not limited to pets, weapons, rurality, history of violence in the home, antisocial behaviour, substance misuse, hoarding, parking restrictions, significant mental health, high rise flat)
Consent*
Referrals will only be accepted where explicit consent from the parent/carer for City Family has been obtained and recorded.
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As part of the Women in the Workplace project, funded by DHSC and run by Pregnant Then Screwed and Best Beginnings, we are excited to share that we have received an Accreditation for the Empowered Foundations training with a focus on women's reproductive health in the workplace. As part of the training, our managers accessed modules based on the topics of pregnancy loss, fertility, flexible working and eliminating bias to better understand the use of language, ways to support members of staff and increase knowledge base around these specific topics. Here at City Family we are striving to improve the support available for the women in our workplace

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