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NHS 'telehealth' pilot - application form

Use this form to apply to be on the NHS adult therapy 'telehealth' pilot. If you qualify to be considered for it, we will pass your information below to Airedale NHS Trust, who will come back to you with more detailed information.

The first half of your postcode.
This is only relevant if there is NHS speech therapy for adults in your area. If there is, let us know why you cannot access it, eg distance or transport involved.