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Refer a patient

Pressure ulcer

If you or someone you care for has a pressure ulcer or symptoms of a pressure ulcer, you can make a self-referral to the skin care team.

To find out how we use this information, our security and your rights visit our privacy page >

Patient details:
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Are you: * required



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Reason for referral

If yes, please state where e.g heel of foot, buttock etc.

If yes, please state where on body.

If yes, please state where on body.

If yes, please state where on body.
Have you had a pressure ulcer before?



If you did please tell us who you received treatment from, eg. community nurses, tissue viability, wound clinic, podiatry, carer or self care.
Do you currently use any pressure relieving equipment?



Are you able to leave your home with minimal assistance and able to sit yourself on a treatment couch? * required



E.g. diabetes, heart disease

You will see a thank you page once the form has been submitted. If you do not see this page then you have overlooked to complete some of the required fields. Please check the form, complete the missing details and resubmit. Thank you.

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