Please only complete this form if you have a letter asking you to do so.
We are undertaking a review of all patients on the Speech and Language Therapy appointment waiting list and would like to understand whether you still need an appointment to be booked. You may have been referred to Speech and Language Therapy due to concerns about your communication and/or swallowing.
If you have significant changes in your symptoms relating to your condition, please speak with NHS 111 or your GP.
Please provide these details so we can find your records: