Take the first steps to confident independent living with restored quality of life by filling in our self-referral form below.
A. Physical (e.g., weakness, poor coordination, fatigue)
B. Sensory (e.g., vision, hearing, numbness, pins and needles)
C. Cognitive (e.g., memory, attention, planning, multitasking)
D. Psychological (e.g., mood changes, anxiety, motivation)
E. Environmental (e.g., home setup, adaptations, equipment needs)
By signing below, I confirm that the information provided is accurate to the best of my knowledge and I consent to this referral being processed.