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INDEPENDENT PHYSIOTHERAPIST SERVICE 
Please complete the form below to request a service from an independent physiotherapist

INDEPENDENT PHYSIOTHERAPY SERVICE

This service is provided by
KIMBERLY MORRIS          BSc (Hons) Physiotherapy
Member of the Chartered Society of Physiotherapy (MCSP)
Her Specialisms are:
Paediatric and adult musculoskeletal physiotherapy, with particular expertise in infant developmental assessment; orthopaedics; neurodevelopmental management; neuromuscular and neurological conditions; and respiratory management involving suction and manual techniques training
Kim says: “I love working closely with parents, carers and healthcare professionals to provide sensitive and effective care”. To find out more about Kim click here

Kim can provide the following services,

Initial Physiotherapy assessment costing £95
An assessment to establish the needs and make recommendations e.g for an EHCP assessment

Additional services, and additional costs:

Follow up Physiotherapy £60
Per session

Pre-tribunal Initial Assessment £165
Inclusive of assessment findings, joint range, strength assessment, postural analysis, background explanation of condition and general overview of movement pattern

Full tribunal report Additional £510, total £675
This would be completed after a Pre-tribunal Initial Assessment and provides Physiotherapy recommendations and objective measures like walking time, pre post intervention results, activities of daily living and how this impacts either the school location or the home location.

School Assessment £ to be agreed
This will be calculated per hour, with mileage and travel costs accordingly.

For all services provided outside of Gloucester, mileage will be charged at 0.60 per mile from postcode GL46GA plus travel time

Following submission of this form you will be contacted to discuss your situation in more detail and to agree costs which must be provided in advance.

Completing the Form

Please complete the form fully, giving as much information as possible.
Once you are at the front of the waiting list the physiotherapist will contact you to arrange a discussion of the services you wish to purchase

Details of person making the request

Please give the name of the person making this request 
Please tell us a number that we could contact you on

Name and Address of person to be assessed

Please give the name and address of the person who is to be assessed
Please highlight all that apply, hold down the control key and click to select.
Please highlight all that apply, hold down the control key and click to select.

Submit

Please click the submit button below to send this form. Once the button is clicked a please wait message should appear, then disappear and be replaced by a thank you message at the TOP of the form. You will then be emailed a copy of the form, showing that it has been submitted.

If this doesn't happen, please scroll up for any error messages, as questions with a red star need to be answered for the form to submit. Any issues click here to contact us
AFTER CLICKING SUBMIT SCROLL UP TO CHECK THAT 'THANK YOU' MESSAGE APPEARS. YOUR PLACE WILL BE CONFIRMED ONCE YOUR PAYMENT IS RECEIVED
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