For Healthcare Professionals

Professional Referral Form

We accept referrals from GPs, case managers, occupational health professionals, insurers, solicitors and PCNs. We aim to contact referred patients within 24 hours.

We accept referrals from

GP practices & PCNs
Case managers
Occupational health providers
Private medical insurers
Solicitors & legal firms
Consultants & secondary care
Employers & HR departments

What we provide

Initial assessment reports
Progress updates on request
Functional capacity evaluations
DSE / ergonomic assessments
Medico-legal reports
FCP (First Contact Physiotherapy)
Case management liaison

📞 01293 529090

✉️ info@prorehab.co.uk

💬 WhatsApp: 07554 990172

Submit a Referral

All fields marked * are required. We will contact the patient directly to arrange an appointment.

Referring Professional

Your name *

Job title / role *

Organisation *

Your contact number *

Your email *

Patient Details

Patient first name *

Patient last name *

Patient date of birth

Patient phone *

Patient email

Referral Details

Service required *

Preferred clinic

Urgency

Funding

Clinical summary / reason for referral *

Any relevant precautions or contraindications

I confirm the patient has consented to this referral and their data being shared with ProRehab Healthcare Group in accordance with their Privacy Policy.

✅ Referral submitted. We will contact the patient within 24 hours and send you a confirmation.