Info for Healthcare Professionals Establishing Eligibility Personal Wheelchair Budget Contact

Making a Referral If you are a Healthcare Professional and want to refer to our service, please download and complete the relevant referral form. We can only accept referrals from appropriately qualified Healthcare Professionals.

Information for Healthcare Professionals

The information on this page is intended to help Healthcare Professionals refer new clients to us. We can only accept referrals from appropriately qualified Healthcare Professionals.

If you are a service user or their family member/carer, please refer to our Service User Information page for guidance and useful information on the services we provide.

Referral Forms


If you are a Healthcare Professional and want to refer to one of our services, please download the relevant referral form here.

If your service is not listed above, please contact their local team directly for a copy of their Referral Form.


Barnet Wheelchair Service - Referral Form (BAR001) Calderdale and Kirklees Posture and Mobility Service - Referral Form (CK001) Kent and Medway Wheelchair Service - Wheelchair Referral Form Kent and Medway Wheelchair Service - Pressure Cushion Referral Form Mansfield Wheelchair Service - Referral Form (MAN001) Staffordshire and Stoke-on-Trent Wheelchair Service - Referral Form (SSOT001) Surrey Wheelchair Service - Referral Form West Hampshire, Southampton & Isle of Wight Wheelchair and Repair Service - Referral Form

GP Referral Forms


If you are a General Practitioner and want to refer to one of our services, please download the relevant GP referral form here. These forms are also imbedded into the GP databases.

If your service is not listed above, please contact their local team directly for a copy of their Referral Form.


Barnet Wheelchair Service - GP Referral Form (Manual Wheelchair) Barnet Wheelchair Service - GP Referral Form (Powered Wheelchair) Calderdale and Kirklees Posture and Mobility Service - GP Referral Form (Manual Wheelchair) Calderdale and Kirklees Posture and Mobility Service - GP Referral Form (Powered Wheelchair) Mansfield Wheelchair Service - GP Referral Form (Manual Wheelchair) Mansfield Wheelchair Service - GP Referral Form (Powered Wheelchair) Oldham Wheelchair Service - GP Referral Form Staffordshire and Stoke-on-Trent Wheelchair Service - GP Referral Form (SSOT013)

Please complete the sections of these forms 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.