{"id":102,"date":"2020-11-02T16:04:03","date_gmt":"2020-11-02T16:04:03","guid":{"rendered":"http:\/\/sites.reading.ac.uk\/slt-clinic\/?page_id=102"},"modified":"2020-11-09T14:41:16","modified_gmt":"2020-11-09T14:41:16","slug":"paediatric-speech-and-language-therapy-services-referral-form","status":"publish","type":"page","link":"https:\/\/sites.reading.ac.uk\/slt-clinic\/paediatric-speech-and-language-therapy-services-referral-form\/","title":{"rendered":"Paediatric Speech and Language Therapy Services &#8211; Referral Form"},"content":{"rendered":"<p>Please complete the form below as this will enable us to plan and make sure that we can help in the most appropriate way.<\/p>\n<p>This form must be\u00a0completed about the person you are referring.<\/p>\n<noscript class=\"ninja-forms-noscript-message\">\n\tNotice: JavaScript is required for this content.<\/noscript>\n<div id=\"nf-form-3-cont\" class=\"nf-form-cont\" aria-live=\"polite\" aria-labelledby=\"nf-form-title-3\" 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form.\",\"currency_symbol\":\"\",\"beforeForm\":\"\",\"beforeFields\":\"\",\"afterFields\":\"\",\"afterForm\":\"\"};form.fields=[{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":1,\"idAttribute\":\"id\",\"label\":\"Full name of your child (including Surname)\",\"key\":\"full_name_of_your_child_including_surname_1645546510557\",\"type\":\"textbox\",\"created_at\":\"2016-08-24 16:39:20\",\"label_pos\":\"above\",\"required\":1,\"placeholder\":\"\",\"default\":\"\",\"wrapper_class\":\"\",\"element_class\":\"\",\"container_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"<p><span data-contrast=\\\"auto\\\" xml:lang=\\\"EN-GB\\\" lang=\\\"EN-GB\\\" class=\\\"TextRun SCXW259007562 BCX0\\\" style=\\\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: 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If yes, please specify\",\"key\":\"does_your_child_have_a_formal_diagnosis_such_as_autism_dyslexia_intellectual_disability_developmental_language_disorder_if_yes_please_specify_1631791518172\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"drawerDisabled\":false,\"desc_text\":\"<p><br><\\\/p>\",\"id\":127,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":35,\"idAttribute\":\"id\",\"type\":\"textbox\",\"label\":\"Have you or anyone else in the child's family ever needed Speech and Language Therapy or had any difficulties with their talking? If yes, please give details\",\"key\":\"have_you_or_anyone_else_in_the_child_s_family_ever_needed_speech_and_language_therapy_or_had_any_difficulties_with_their_talking_if_yes_please_give_details_1631790539557\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"drawerDisabled\":false,\"desc_text\":\"<p><br><\\\/p>\",\"id\":128,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":36,\"idAttribute\":\"id\",\"type\":\"textbox\",\"label\":\"Does anyone in the child's immediate family have a formal diagnosis such as Autism, Dyslexia, Intellectual Disability, Developmental Language Disorder?\",\"key\":\"does_anyone_in_the_child_s_immediate_family_have_a_formal_diagnosis_such_as_autism_dyslexia_intellectual_disability_developmental_language_disorder_1631790611160\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"drawerDisabled\":false,\"desc_text\":\"<p><br><\\\/p>\",\"id\":129,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":37,\"idAttribute\":\"id\",\"type\":\"textarea\",\"label\":\"What interests your child? 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