Skip to content

Hydrotherapy swimming pool hire, warm water swimming pool, aquatic physiotherapy, hydrotherapy, aquatic therapy self practice, physio-led groups, massage therapy, disabled swim, hoist to water, swimming lessons, SEND swimming lessons, 1:1 swimming lessons, pre-school swimming lessons, school age swimming lessons, adult swimming lessons, beginners swimming lessons, individual swimming lessons, siblings swimming lessons, swimming lessons in small groups, baby swimming lessons, toddler swimming lessons, parent & child swimming lessons

Payments

Choose Your Service

Details of Your Booking

Park House Spa Hydrotherapy Swimming Pool Reading UK

Log in
Entries feed
Comments feed
WordPress.org

1 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

Proudly powered by WordPress