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Hydrotherapy swimming pool hire, aquatic physiotherapy, hydrotherapy, aquatic therapy self practice and groups, massage therapy, disabled swim, swimming lessons: SEND, water fear, pre-school, school age, adult beginners, individual, siblings, small groups, baby & toddler swimming

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Site Content

I. Park House Spa
- How to find us
- Our Facilities
II. Availability and Bookings
III. Enquiries
IV. Private Hire
V. Aquatic Therapy
- GP Referral Programme
VI. Swimming Lessons
VII. Testimonials

Park House Spa Hydrotherapy Swimming Pool Reading UK

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Aquatic Therapy Referral Form

Name *

First

Last

Date of Birth *

DDMMYYYY

Address *

Mobile Phone Number *

Email *

Referring GP / Specialist *

First

Last

GP Address *

Type of Intervention *

Disease modifying aquatic therapy
Symptomatic relief
Recreational swim or exercises

Condition/s requiring aquatic therapy *

Therapeutic aim *

Is progress/attendance report required? *

Yes
No

5. Required services in hydrotherapy pool *

1to1 Aquatic physiotherapy session
Physio led aquatic group therapy Arthritis
Physio led aquatic group therapy Knee / Hip replacement
Physio led aquatic group therapy Back pain and balance
Aquatic therapy self-practice with individual exercise card
Group Aquatic therapy self-practice with individual exercise card
Aquatic fitness group
Disability swim
Swimming lessons SEND child
Swimming lessons adult

Contraindications for Aquatic Therapy (see separate form) *

Not assessed
No contraindications identified
Other (please give details below)

Details regarding Contraindications

Mobility and assistance required from the site *

Not assessed
Wheelchair access
Hoist to water from changing table or wheelchair
Steps to water
Hoist operating assistance
Poolside care giver assistance
In water assistance

Water confidence (pool depth 1.35m) *

Not assessed
Confident swimmer
Swimmer
Non swimmer over 1.5m height
Non swimmer under 1.5m hight
Water fear

Form Completed by *

First

Last

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