Your browser does not appear to support JavaScript. You may want to try one of the following:
Sorry, something's gone wrong with this form.
This may have happened because the form was open for a long time.
We haven't saved any personal information you entered. We do this for your security.
Try loading the form again:
If this doesn't work, please use the website feedback form to tell us there's a problem.
Show details
Hide details
This form is for the public. If you're a health care professional fill in an Occupational Therapy referral for professionals
To make a referral for a child use our Occupational Therapy for a child form.
Your referral will be rejected if:
To fill in this form, you might need your, or the adult's:
Tell us about a problem with a form, page or Citizen Portal account