Get the free Adult Continence Self-Referral Form

Adult Continence SelfReferral Form Please return the form to: Continence Promotion Service Community Clinic 2 St Charles Center For Health & Wellbeing Ex moor Street London W10 6DZ TEL: 0208 962 4546

How to fill out adult continence self-referral form

How to fill out an adult continence self-referral form:

1. Start by gathering all relevant personal information, such as your full name, date of birth, address, and contact details. This information is necessary for the healthcare providers to properly identify and reach out to you.
2. Specify the reason for your referral on the form. In this case, indicate that you are seeking assistance with adult continence issues. Be honest and open about your symptoms and any specific concerns you may have.
3. Include a detailed medical history, listing any underlying conditions or previous treatments related to urinary or fecal incontinence. This information helps the healthcare professionals understand your background and tailor their approach to your specific needs.
4. Describe any current medications you are taking that may affect your continence, including dosage and frequency. This allows the healthcare providers to assess if any medications could potentially be contributing to your symptoms.
5. Indicate whether you have had any recent surgeries or procedures that could be linked to your continence issues. This information helps the healthcare providers understand any potential underlying causes and develop appropriate treatment plans.
6. Provide a summary of your symptoms and their impact on your daily life. Include details such as frequency, severity, and any limitations or concerns you may have regarding your continence. This information assists the healthcare team in assessing the urgency and appropriate level of care required.
7. If applicable, mention any previous referrals to specialists or relevant healthcare professionals regarding your continence issues. This helps to ensure continuity of care and prevent duplication of efforts.

Who needs an adult continence self-referral form?

1. Individuals experiencing urinary or fecal incontinence: This form is designed for adults who are having difficulties controlling their bladder or bowel movements. It allows them to self-refer for specialized continence assessment and potentially receive appropriate treatment and support.
2. Those seeking professional guidance and support: The adult continence self-referral form is appropriate for individuals who feel they would benefit from the expertise of healthcare professionals in managing and treating their continence issues. It is an opportunity to access specialized care and resources.
3. Those wanting to improve their quality of life: The self-referral form is suitable for individuals who aim to address their continence concerns to enhance their overall well-being. Seeking professional help can lead to a better understanding of the underlying causes and potential treatment options, ultimately improving their quality of life.

For pdfFiller’s FAQs

Can I sign the adult continence self-referral form electronically in Chrome?

Yes. By adding the solution to your Chrome browser, you can use pdfFiller to eSign documents and enjoy all of the features of the PDF editor in one place. Use the extension to create a legally-binding eSignature by drawing it, typing it, or uploading a picture of your handwritten signature. Whatever you choose, you will be able to eSign your adult continence self-referral form in seconds.

How do I edit adult continence self-referral form straight from my smartphone?

You may do so effortlessly with pdfFiller's iOS and Android apps, which are available in the Apple Store and Google Play Store, respectively. You may also obtain the program from our website: https://edit-pdf-ios-android.pdffiller.com/. Open the application, sign in, and begin editing adult continence self-referral form right away.

How do I fill out adult continence self-referral form on an Android device?

Use the pdfFiller mobile app and complete your adult continence self-referral form and other documents on your Android device. The app provides you with all essential document management features, such as editing content, eSigning, annotating, sharing files, etc. You will have access to your documents at any time, as long as there is an internet connection.

What is adult continence self-referral form?

The adult continence self-referral form is a form that allows individuals to request help and support for continence issues.

Who is required to file adult continence self-referral form?

Any adult who is experiencing continence issues and wants to seek help and support.

How to fill out adult continence self-referral form?

The form can be filled out online on the official website or can be requested from healthcare providers.

What is the purpose of adult continence self-referral form?

The purpose of the form is to provide individuals with a way to request help and support for continence issues in a confidential and convenient manner.

What information must be reported on adult continence self-referral form?

The form may require personal information, details of the continence issue, medical history, and contact information.