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Make A Referral

Please provide as much information as possible on this referral form, as it will help us to choose the most appropriate member of the Kids Feeding Team, for the initial discussion.

If you would like to refer your child to our services then please complete the following form and we will be in touch.

All of the information you provide will be kept confidential. By completing this form you confirm that you have parental responsibility for the child or young person you are referring.

Niamh Gilligan,
Paediatric Dietitian,
BSc (Hons) Dietetics

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Your Details

Child's Details

Please feel free to attach any relevant documentation or reports with this referral. If there is more than one document please attach as a zip file.

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Next Steps

To speak to us about any of the treatments we provide please email call 0161 820 8262.

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