Assessment and prescription form for specialist pressure relieving equipment

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The following form is for use by healthcare professionals only.


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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.

Please note the following changes to the service:

For same-day installation, requests must be received before 1pm.

Dynamic mattress equipment to support hospital discharge must be ordered at least 48 hours in advance.