Adult Speech and Language Therapy Referral Form


Patients who live in Gloucestershire can be referred to us through their GP and other members of their healthcare and therapy team.

We also welcome patients referring themselves, regardless of of age, language, presenting difficulty or location.

The following exception applies:
Voice disorders (dysphonia) – referral must be made following examination of the larynx by an ear, nose and throat (ENT) surgeon. This referral requires the patient’s consent.

Swallowing disorder referrals need to be made by a medical professional or a member of the MDT i.e. physiotherapist, nurse, social worker, dietician.

If you aren’t sure whether speech and language therapy could help you, please call us on 0300 422 8105 and ask to speak to a speech and language therapist who will be able to advise you.