Referral forms to download

Click on the above referral form to open. You can complete the form in two ways:

Option 1) complete electronically and then click the top right download button (downward arrow) and click ‘save with changes’. You can then save and email to us to the email address on the form.

Option 2) print and complete the document, then scan and return to us via email or alternatively post a completed copy to the address on the form.

Please ensure you attach at least 4 days of food charts to your referral and complete all the mandatory information fields. Incomplete referrals will be rejected and returned. 

Referring to the Community Dietitians

Care homes can now refer directly to the community dietitians using the Community Dietetic Referral form for Care Homes. We recommend carers follow our guidance in the MUST Care Pathway for Care Homes in Somerset before referring.

Please note referral forms should be emailed from a secure email account. If your care home does not have a email account we recommend referrals are sent via post to the following address:

Somerset Community Dietetic Service

2nd Floor, Mallard Court

Express Park

Bristol Road




If you have a secure NHS email account please e-mail completed referral forms to:

If you are having difficulty completing or sending the referral form please do not hesitate to contact us to discuss by emailing: or calling us on 01278 447407