The nocturnal enuresis intervention is only for children and young people that are night-time wetting and age seven years old or above. Please complete the below form.

We do not see children with constipation or soiling - please contact your GP.

If you need support around toileting or daytime wetting, then please complete the school nursing request for support form. 

And for support for night-time wetting for an under seven year old, please also complete the school nursing request for support form. ​​​​​​​

Referrer details

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Required

Patient details

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ECHP in place? Required
Required
Required
Child in care? Required
Military family Required
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Required

Reason(s) for referral/symptoms

Reason Required
Required

Additional information - to be completed by the GP if these checks have been completed

Please note that a spinal check, abdominal examination and a urinalysis needs to be completed by a health professional prior to referral being made and the results written below along with a brief outline of the continence problem and also any advice/treatment that has already been trialled:

Medical history

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