EMERGENCY PHYSIOTHERAPY SERVICE 
GLOUCESTERSHIRE RESIDENTS ONLY
Please complete the form below for referral for an online physiotherapy consultation about the 
PERSON THAT YOU CARE FOR

ONLINE PHYSIOTHERAPY CONSULTATION

This service is for Carers living in GLOUCESTERSHIRE, who need one session of advice to

  • understand the impact/prognosis of a diagnosis/injury/operation for the person that they care for, 
  • to know what to look out for, and
  • to safely provide care within their own physicality
The service is provided by KIMBERLY MORRIS          BSc (Hons) Physiotherapy
Member of the Chartered Society of Physiotherapy (MCSP)

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

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 an appointment for online advice.

Please tell us a number that we could contact you on
Please highlight all that apply, hold down the control key and click to select.
Please describe what diagnosis/injury/operation you would like advice about
Please give a brief description

FEEDBACK

The Parent and Carer Alliance C.I.C. is only able to get funding to provide services such as this one, through Grant funders, such as the Carers Gloucestershire Legacy fund and the Gloucestershire Community Foundation.
For funding to continue to be given, the Alliance needs to demonstrate how the support we provide helps families like yours. We need YOUR HELP and FEEDBACK to do this, as telling us what worked for you, helps funders understand why these services are needed

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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