Family Services Directorate

CHILDREN’S THERAPY DEPARTMENT

Children's Centre, Damers Road, Dorchester, Dorset DT1 2LB

Tel: No: (01305) 254744

PHYSIOTHERAPY & OCCUPATIONAL THERAPY REFERRAL FORM

NAME: D.O.B.:

ADDRESS HOSPITAL NO.:

CONSULTANT:

POST CODE:

TELEPHONE NO.: G.P./H.V.

NAME OF PARENT/CARER:

SCHOOL: C.M.O.:

Other agencies involved, eg, SALT, SW, Educational Psychology, Portage

Please indicate to which service you are referring:

OT PT BOTH

Diagnosis and reason for referral:

Additional clinical information:

Please indicate if previously seen by Children’s Therapy: YES / NO Year?

Date of next clinic/review:

Signed: ………………………………………… Date: …………………………….

Designation: ……………………………………

Please return to:

WARREN SANDELLS, HEAD OF CHILDREN’S THERAPIES, DORCHESTER,

DT1 2LB

INFORMATION FOR REFERRERS

The Children’s Therapy Department is an integrated physiotherapy and occupational therapy service for children from 0 years to school leaving age. Each referral is prioritised according to need and an appointment offered as soon as possible. We try to do a joint assessment for children referred for both physiotherapy and occupational therapy. Where possible, the children are given an appointment for the location nearest to their home. However, it may be necessary for the child to be seen at the Children’s Centre for some joint assessments, special groups, specialist clinics, or certain therapy sessions.

After the initial assessment a report will be sent to the referrer. If treatment is offered, a programme with aims and goals will be drawn up after discussion with parents. Home programmes are given as appropriate. The therapists work closely with all other members of the health care team. School visits and other liaison visits are made as necessary, with the consent of the parents. The therapists advise education staff on the child’s activities and a school programme given which may be incorporated into classroom and PE sessions.

At the end of treatment, a discharge plan will be made and a final report sent to the referrer.

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