If you would like support from Blackpool School Nursing Service, please complete the Request for School Nurse Support form.

This will be triaged by our duty team and a practitioner will be in touch in due course.

If you are requesting support on someone else’s behalf, please ensure you have gained consent prior to asking.

Child's details

Required
Required
Date of birth Required
Required
Address Required
Required
Required
GP's address Required
Required
Please indicate if this child is:
Have you have obtained parental consent?
Date consent obtained
Have you obtained the young person's consent?
Date consent obtained

Requester details

Required
Required
Required
Required

Parent/carers details

Required
Required
Required
Required
Preferred method of contact

Is this a school nurse drop-in request?

Reason for request

Required