For general ICAN referrals and referral criteria, please use the form below (this includes community paediatric clinics, paediatric neuro-disability, audiological medicine, growth and nutrition, occupational therapy and physiotherapy):

• General ICAN referral form

Use this form for nurse-led daytime and night-time wetting:

• Referral form for nurse-led daytime and night-time wetting services

Please send all completed forms to ican.referrals@nhs.net.

If you need this document in an accessible format please contact ican.referrals@nhs.net.

Please use the specialist referral forms on the following service pages for:

• Audiology 
• Eye service
• Community paediatricians
• Adoption and fostering
• Springfield Neonatal Follow Up Clinic
• Nursing
• Continuing care nursing and short breaks
• Hannah House
• Inclusion nursing