Use this form to request an autism spectrum disorder (ASD) assessment.
You can use this service if you:
- are registered at the surgery
Before you start
We’ll ask you for:
- your first and last name, date of birth, sex, postcode, email and phone number
- if applicable, the details of the person you are completing the form on behalf of
Important: Important Notice
To be completed by adults only.
If you are under 18 please do not complete this form, thank you.
You can also phone us on 01264 361424.