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What We Do
Full Upper Limb Assessment and Diagnosis
Splinting
Strength and Movement
Wound Care
Scar Management
Swelling Control
Sensation Including Re-Education And Desensitisation
Activity Modification
Ergonomic Modification
Lymphoedema Management
Vascular Conditions Management
Burns Management
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Carpal Tunnel Syndrome
De Quervain’s
Dupuytren’s Disease
ECU Tendinosis
Finger Amputation
Finger Fractures
Flexor Tendon Injury
Flexor Tendon Repair
Ganglion – Cyst
Osteoarthritis
Rheumatoid – Arthritis
Scaphoid – Fractures
Scapholunate – Ligament Injury
Tennis Elbow
Thumb – Collateral Ligament
Thumb – Fractures
Trigger-Finger
Ulna – Nerve Compression
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Hand Therapist
Lymphoedema Therapist
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Referral Form
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Referral Form
Specialist Assessment And Treatment Of Hand, Wrist And Elbow
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Patient Name
(Required)
DOB
(Required)
DOB
(Required)
Address
(Required)
Phone Number
(Required)
Diagnosis/Surgery Details
(Required)
Therapy Requested:
Assessment & Treatment
Mobilisation
Desensitisation
Splinting
Strengthening
Other
Scar Management
Oedema Control
Other (Please Specify)
Therapy / Rehabilitation Instructions / Precautions
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Referred by:
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Provider No:
Date
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