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Occupational Therapy Contact Form

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Occupational Therapy Specialist Assessment

You can complete this form for yourself or on behalf of someone else, ie if you are a carer, relative or friend.

How to navigate

Click on the numbered sections on the left hand side of the screen
or
click the Click on the numbered sections on the left hand side of the screen or click the and options to move through the pages. Don't use the browser 'back' button, these will look like one of these examples below (Internet Explorer (left) and Chrome (Right)) image. and Click on the numbered sections on the left hand side of the screen or click the and options to move through the pages. Don't use the browser 'back' button, these will look like one of these examples below (Internet Explorer (left) and Chrome (Right)) image. options to move through the pages.
Don't use the browser 'back' button, these will look like one of these examples below (Internet Explorer (left) and Chrome (Right))
Click on the numbered sections on the left hand side of the screen or click the and options to move through the pages. Don't use the browser 'back' button, these will look like one of these examples below (Internet Explorer (left) and Chrome (Right)) image. Click on the numbered sections on the left hand side of the screen or click the and options to move through the pages. Don't use the browser 'back' button, these will look like one of these examples below (Internet Explorer (left) and Chrome (Right)) image.

The form

Questions You DO NOT need to answer every question, you need only complete what is relevant to you. image. Questions

You DO NOT need to answer every question, you need only complete what is relevant to you.
Select the option(s) that best describe your situation. image. Select the option(s) that best describe your situation.
This symbol This symbol indicates that the question is mandatory and must be answered in order to continue. image. indicates that the question is mandatory and must be answered in order to continue.

Options

Save the form

Please note that the system is set to timeout after a period of 15 minutes of inactivity. If you need to leave your assessment and return to it later please select the save option.
Use the Save the form Please note that the system is set to timeout after a period of 15 minutes of inactivity. If you need to leave your assessment and return to it later please select the save option. Use the option to Save the form to return to at any time. image. option to Save the form to return to at any time.

Print the form

Use the Print the form Use the option to print a copy of the form if required. image. option to print a copy of the form if required.

Having difficulty understanding the assessment process?

Community ConneX provides independent, trained advocates for people in Luton, called advocacy.
Advocacy is available for adults who may need extra support, including people:
  • with learning disabilities
  • with mental health needs
  • with autism
  • with sensory or physical disabilities
  • who struggle to get their voice heard
It is a free, confidential support from someone who speaks up with you and helps you get your views heard.
An advocate can help you:
  • say what you want and ask questions
  • understand information and make decisions
  • attend meetings
  • sort out issues with things like benefits, health appointments or services
  • make calls or write letters
An advocate will not tell you what to do or make decisions for you.
Community ConneX
Email: advocacy@communityconnex.co.uk
Telephone: 01582 314 183
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