Liverpool City Council

Occupational Therapy Request
Summary

Tell us about who's completing the form

Who is the assessment for?

You
Someone else

Please complete the Occupational Therapy Service User form.

Are you a:

professional (e.g. GP, health worker, therapist or other professional)
relative, carer, friend or advocate

Please complete the Occupational Therapy Professional Referrals form.

Please complete the Occupational Therapy Request Relative, Friend, Carer or Advocate form.

This notes field wll never be shown - it's just here to make the styling consistent.

Before you submit this form please review your answers below. If you need to change anything, use the 'previous' button on the bottom left to go back to a section. Then submit the form by selecting the 'Submit button' at the bottom of this page