The intake team have reviewed your referral and accepted your booking.

To keep your appointment, please complete the form at least 2 to 6 weeks prior to the appointment.

Note:

The Vanderbilt Assessment may take a few weeks to complete (e.g. by the teacher) - allow extra time for this
You may need to book to see your GP for the required measurements prior to your appointment
Please have a copy of these results/assessments/medication list ready on the day of your appointment (required)
If we do not receive a completed form at least two weeks before your appointment the Lionheart Clinic Team reserves the right to cancel or rebook your appointment
Our team prefer not to do this - we would greatly appreciate it if you can start getting these results in to us

For any other questions, you can contact us through the contact page here

Our Lionheart Team look forward to hearing from you

Review Form

Form ID: FDMX202

Patient

First Name

Last Name

Middle Name(s)

Date of Birth

YYYY

I am a

Phone Number

Height

Weight

Blood Pressure

Heart Rate (HR)

Abdominal Exam

Tonsil Exam

Cardiovascular Exam

ECG

I acknowledge I am responsible for having a copy of my assessment/results on the day of the assessment.

I acknowledge I have read and agree to the instructions that unless I provide all the above AT LEAST 2-6 weeks prior to the initial assessment, the appointment will be cancelled

Message (optional)

The intake team have reviewed your referral and accepted your booking.

To keep your appointment, please complete the form at least 2 to 6 weeks prior to the appointment.

Note:

The Vanderbilt Assessment may take a few weeks to complete (e.g. by the teacher) - allow extra time for this

You may need to book to see your GP for the required measurements prior to your appointment

Please have a copy of these results/assessments/medication list ready on the day of your appointment (required)

If we do not receive a completed form at least two weeks before your appointment the Lionheart Clinic Team reserves the right to cancel or rebook your appointment

Our team prefer not to do this - we would greatly appreciate it if you can start getting these results in to us

For any other questions, you can contact us through the contact page here

Our Lionheart Team look forward to hearing from you

Review Form

Form ID: FDMX202

We will then email or call you to provide you additional information