Patient Referrals

Complete the form below for your patient and a member of the SB Health team will be in touch.

Information gathered here will not be passed on to anyone else and will be processed in accordance with the requirements of the Data Protection Act 2018.

Patient referral form

Referring health professional's name(Required)

Health professional's email address

Hospital/ centre name

Health board

Hospital /centre phone number(Required)

Patient name

Patient email address

Nearest Town/City

Which programme would you like to refer the patient to?(Required)

Multiple sclerosis: SB Elevate®

Parkinson's: Dance for Parkinson's Scotland

Dementia: Time to Dance®

Long Covid Support

They would be interested in:

In-person classes

Online classes

On demand, pre-recorded resources

Permission(Required)

I confirm that I have consent from my patient to make this referral

Name

This field is for validation purposes and should be left unchanged.

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