The Leeds Teaching Hospitals NHS Trust

Information for Professionals

Referral Forms

Please find below referral forms for Leeds Wheelchair Service

Wheelchairs Referral GP (160 KB)

Wheelchairs Referral Approved Therapists (509 KB)

Wheelchair re-referrals

'please note - these documents are password protected, if you have not already been issued with a password please email: with your name, designation, location and full contact details to obtain a password'.

Please find below referral forms for Orthotics and Prosthetics

Orthotic Referral form

Hosiery Referral form

Prosthetic referral form

Personal wheelchair budget

PWB leaflet

If you have any queries please contact us.