Lakeland Dialysis
Lakeland Dialysis
Cockermouth, Cumbria
01900 822 888

Download Forms

You will find all the forms that you need to make a dialysis booking below. All forms are in an easily printable PDF format.

Booking Form
Date Modified: 05/03/2018
Please complete this form and return at the time of your booking enquiry.
Terms and Conditions
Date Modified: 21/02/2018
This document states the terms and conditions set out to your nurse, co-ordinator that we expect you to uphold whilst in our care.
Dialysis Prescription
Date Modified: 21/02/2018
This gives us the information we require in order to carry out your dialysis treatment and must be signed by a doctor or nurse prescriber. Please return 2-4 weeks before your visit.
Medical Information
Date Modified: 21/02/2018
This gives us your latest blood, MRSA status and mobility needs. Please return this form 2-4 weeks before your visit.
IV Iron Prescription
Date Modified: 21/02/2018
This form is required to be signed by a Doctor / Nurse Prescriber in order for Lakeland Dialysis to administer Intravenous Iron.
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Dialysis Facilities