Speech and Language Therapy Dysphagia Referral Form

WE ARE UNABLE TO ACCEPT INCOMPLETE FORMS (boxes with * are mandatory)

Note: To ensure a resident will be seen, an online referral form should be received 24 hours before the SLT visit is due.

I have completed the Referrals Flowchart* and the result indicates this referral is appropriate *

Consult the Referral Dysphagia Advice Leaflet ** 

To download/print a copy of this form, please click here. Once complete, please email to saltreferrals@nualtra.ie