Occupational therapy referral form for the public

This form is for the public. If you're a health care professional fill in an Occupational Therapy referral for professionals

To make a referral for a child use our Occupational Therapy for a child form.

Your referral will be rejected if:

• the person has had an acute period of ill health, or is awaiting or recovering from surgery. Contact the GP and ask for a referral to Sirona Community Therapy Team
• you're requesting a mobility assessment or rehabilitation for activities of daily living, such as cooking or dressing. Contact the GP and ask for a referral to Sirona Community Therapy Team
• you're requesting a wheelchair assessment or repair. Contact the GP to request a referral to the Wheelchair Service Bristol Centre for Enablement or call 0300 300 0110
• you're requesting Technology Enabled Care (TEC). Use the adult social care online referral form or call 0117 922 2700
• the person works for, or lives in, a Housing Association and are requesting minor adaptations including Keysafes (under £1,000). We would expect the Housing Association to provide this, including the measuring up of these which can be provided by the Trusted Assessors in your organisation
• you're requesting furniture. We will only consider the seating needs of people who cannot sit unsupported and would otherwise remain in bed (high level postural needs)

To fill in this form, you might need your, or the adult's:

• medical information
• tenancy type, if Housing Association
• approximate height and weight

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You should complete the form in one go. It might time-out if left and you will lose the information you've entered.