Virtual Multi-Disciplinary Team Meetings Booking Form

Expert support with complex wound care, lymphoedema, podiatry and dermatology cases. Evidence-based advice from specialist clinicians.

Please complete the form below:

You will receive an email shortly from the Accelerate Team confirming your application.

Please don’t hesitate to email us if you have questions.

Virtual MDT payment - CREDIT CARD

"*" indicates required fields

REFERRAL DETAILS

Name*

Job title / role*

Place of work - NHS Trust / Company*

Address

Street Address Address Line 2 City ZIP / Postal Code

Email*

Contact number*

PATIENT DETAILS

Name*

NHS Number*

REASON FOR DISCUSSION

Please check all which apply

Non healing or complex wound

Suspected primary lymphoedema

Under the age of 18

Diagnosis of lipoedema

Complex patient for discussion

Biomechanical abnormalities impacting function, healing, or comfort

THE ISSUE YOU WOULD LIKE TO DISCUSS

Please try using the SBAR framework to describe the patient:
Situation: Outline the concern you have about the patient
Background: Include their relevant medical history, what you have tried already?
Assessment: What do you think the underlying problems might be? Are there any barriers that you can identify?
Recommendation: What would you like to achieve from the MDT discussion?

Situation - Outline the concern you have about the patient*

Background - Include their relevant medical history, what you have tried already?*

Assessment - What do you think the underlying problems might be? Are there any barriers that you can identify?*

Recommendation - What would you like to achieve from the MDT discussion?*

MDT Meeting*

The cost for the MDT will be charged directly to your ICB, once costs are approved

Price:

Virtual Multi-Disciplinary Team Meetings Booking Form

To find out more

Virtual MDT payment - CREDIT CARD

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