This general information will allow our team to prepare for your appointment and ensure the relevant equipment is available.
If you answer no, this may prevent us from being able to assist you fully or provide you with the specialist services you are seeking from our organisation.
Summary of why the referral has been sent. What are the difficulties the person is having? What are their strengths / abilities? Include any relevant details relating to the person, their carers and environment
Please list any specific equipment items you wish to view. Please note, although we will endeavour to obtain these for the appointment, there is no guarantee of availability
e.g. difficulties with hearing, vision, speech, devices used, level of assistance required
e.g. height, weight, bariatric, petite