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Accessing the Service (Referrals)

We accept referrals from GPs, therapists and community nurses. To submit a referral, please click the link below to open the referral form. We do not accept paper, fax or telephone referrals.

To submit a referral you will require a password. To obtain the password please call 0114 271 5807 then choose the options for 'wheelchairs' and then 'appointments'.

Click here to complete a referral form 

Please only submit a referral from an email account

If you have any difficulty opening/completing the form in the browser, please follow these instructions:

• Right click the link and choose 'Save target as' or 'save link as' and then click 'Save' in the window that pops up, accepting the default location of 'Downloads'.

• When the file has downloaded click ‘Open’ in the options at the bottom of the browser window. This should open the file in Adobe Acrobat. Enter the password. You will need to click on ‘Enable All Features’ at the top of the screen to activate the form. Re-enter the password if requested.

Complete the form and click on submit to email the form to

If this fails, save the completed form by clicking on ‘File’ in the menu bar at the top of the browser window, then click ‘Save as…’, then ‘Save’. When prompted if you want to replace the existing file, select ‘Yes’.

Once you have saved the completed form email it as an attachment to from your own email account/address.

Once your referral has been received we will contact you by letter to let you know what’s next. Therefore, it is important that the healthcare professional referring you has your up-to-date address.

If you already have a wheelchair from us, or you have previously been seen by our clinicians, you may be able to re-refer yourself without your GP or other healthcare professional having to submit another referral. In these situations, please ring our admin team on 0114 2715807.



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