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Physiotherapy application form

Please note: This form is an application for physiotherapy assessment and treatment. Residential stays at St Michael’s Lodge are not booked directly and are only considered following clinical assessment where appropriate.

    Please note: If available, please bring any treatment protocols/x-rays/scans/medical reports to your appointment that may be of benefit to our physiotherapists.

    Personal information which you supply to us may be used in several different ways, for example: To make admission and clinical decisions; for audit and statistical analysis; for fraud prevention.

    The Ben Fund is committed to protecting your privacy and security. Whenever you provide personal information, we will treat that information in accordance with UK Data Protection legislation. Further details can be found in our Privacy Policy which can be found on our website at: https://www.thebenfund.co.uk/privacy-policy.

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