Please note: The following information is intended to help healthcare professionals refer new clients to us. We can only accept referrals from appropriately qualified healthcare professionals. If you are an existing service user, please contact us directly.

Information Guides

We have put together some guidance and considerations for Healthcare Professionals. Please download the relevant version for the service you are referring into:

Referring an Adult for a Powered Wheelchair Guide (167)

 East Sussex Wheelchair Service (ESX176)
 Kent & Medway Wheelchair Service (KEN167)
 Surrey Wheelchair Service (SUR167)

Referral Forms

If you are a healthcare professional and want to refer to our service, please download the relevant referral form below:

 Referral Form - Calderdale and Kirklees Wheelchair Service

 Referral Form - Dudley Wheelchair Service

 Wheelchair Referral Form - Kent and Medway Wheelchair Service

 Pressure Cushion Referral Form - Kent and Medway Wheelchair Service

 Referral Form - West Hampshire, Southampton and Isle of Wight Wheelchair & Repair Service

 Referral Form - Mansfield Wheelchair Service

 Referral Form - Oldham Wheelchair Service

 Referral Form - Solihull Wheelchair Service

 Referral Form - Surrey Wheelchair Service

 Referral Form - Tameside Wheelchair Service

GP Referral Forms

If you are a GP and want to refer to one of our services please download the relevant GP referral form below: 

 GP Referral Form - Kent and Medway Wheelchair Service

 GP Referral Form for a Manual Wheelchair - Mansfield Wheelchair Service

 GP Referral Form for a Powered Wheelchair - Mansfield Wheelchair Service

 GP Referral Form - Oldham Wheelchair Service

 GP Referral Form - Solihull Wheelchair Service

 GP Referral Form - Tameside Wheelchair Service

These forms are also imbedded into the GP databases.

Please complete the sections of the referral form that are relevant for your service user and the equipment that they require. Sending an incomplete referral may result in your referral being delayed or rejected.

You can complete our referral forms ‘on-screen’ using Adobe Acrobat software. This is available for free from Adobe. We recommend you “print to PDF” after completing your referral and send it to us using an encrypted email service. 

Establishing Eligibility

The Commissioners, under guidance from NHS England, have created the eligibility criteria for Wheelchair Services. Referrals must meet the criteria to be accepted, so please read them carefully to make sure your client is eligible for the service. 

If your service user requires a short term loan of a wheelchair, please contact the Red Cross (other providers may be available).