Confidentiality ! - There are no mandatory boxes on this application.
For Referrers not wishing or permitted to disclose client information, the only essential information we require is your own contact details in the 'Referrer' section below.
Any additional information that does not conflict with the above such as 'Description of Problem' is helpful. The first half of the client's postcode is useful in giving us some idea of travel involved but not essential.
Note: In cases where the ‘EU Medical Devices Directive’ [MDD] may be applicable, procedures are in place to ensure compliance with the Directive.
The simplest and most reliable way of ensuring your referral reaches us in confidence is as follows:-
Complete the form online. Go to 'Edit' at the top of your browser > 'Select All' > right click and 'Copy'. Left click on this page (to clear the highlight) >click on our email address here - remapleeds@btinternet.com - or on the 'Contacts' page and 'Paste' into the body of the message.
Alternatively, this referral form can be completed online and printed to be sent by post to the address on the 'Contacts' page. It may also be printed with blank entries for photocopying or completion by hand if preferred.