Questionnaire – KURClinic

Referrers
Pathways
Programme
Treatment
Our Approach
Questionnaire
About

Referrers
Pathways
Programme
Treatment
Our Approach
Questionnaire
About

Make a Referral

Who We See

Are you ready for KUR?

Patients generally fit one of the profiles below. If one or more resonates, KUR may be the right next step.

Clinical Assessment

Refer a patient to KUR Clinic.

Please complete the following to refer a patient to KUR Clinic. All information is held securely and in strict confidence.

You may be right for KUR if you:

Have a chronic or persistent condition that has resisted conventional treatment
Have seen multiple specialists without a clear, coordinated plan
Experience symptoms that span physical, psychological, and nervous system dimensions
Are ready to commit to a structured programme — not ongoing trial and error
Want to be guided by a clinical team, not left to navigate the system alone

Patients come to KUR from across all four pathways:

Chronic pain — persistent, complex, and treatment-resistant
Complex musculoskeletal conditions — structural, post-operative, or longstanding
Psychosomatic disorders — where body and mind are inseparable
Autonomic nervous system disorders — affecting energy, sleep, stress, and recovery

The Next Step

Ready to find out if KUR is right for you?

Step 1 of 5 — Your PathwaY

Which pathway might be right for you?

Select all that apply. If you are unsure, tick the last option and we will help you decide.Chronic PainComplex Musculoskeletal ConditionsPsychosomatic DisordersAutonomic Nervous System DysregulationUnsure — I would welcome a clinical discussion

Our clinical team will be in touch with you shortly. Please proceed to fill in the questionnaire for now to help us understand how we can assist you.

Step 2 of 5 — Your Condition

Your presenting condition.

Please share as much detail as you can. This helps us assess which pathway is most appropriate.

Do you have a formal diagnosis?YesNo

Please specify

What is your main presenting complaint?

How long have you been experiencing this?

What treatments or therapies have you already tried?Select all that apply.PhysiotherapyOsteopathyAcupunctureChiropracticPsychology or psychotherapyMedicationSurgeryPain management clinicOther

Please share more information below:

Step 3 of 5 — Medical History

Your medical history.

This helps our clinical team understand the full picture before your assessment

Do you have any pre-existing conditions?YesNo

Please list your pre-existing conditions here:

Are you currently seeing any specialists?YesNo

Please tell us what specialist you are currently seeing:

Step 4 of 5 — Referral Details

Referral details.

Are you self-referring, or have you been referred by a clinician?I am self-referringI have been referred by a clinician

Please provide further information

How did you hear about KUR?

Please share more information below:

Step 5 of 5 — About You

Finally, tell us about you.

We will use these details to get in touch with you regarding next steps.

First Name *

Last Name

Date of birth

Email Address *

Phone *

Where are you based?

I consent to KUR Clinic storing and processing the information I have provided for the purpose of assessing my suitability for the programme. I understand this information will be held securely and will not be shared without my consent.

Which pathway may be suitable for you?

Chronic Pain Complex Musculoskeletal Conditions Psychosomatic Disorders Autonomic Nervous System Dysregulation Unsure — I would welcome a clinical discussion I am not sure yet

Formal diagnosis?

Yes No

Main complaint / symptoms

Duration

Therapies tried

Physiotherapy Medication Exercise Therapy

Pre-existing conditions

Current specialists

How are you referred?

Self-referring Referred by clinician

Consultant-led integrated care for complex and chronic conditions

Navigate

For Referrers
The Pathways
The Programme
Treatment
Our Approach
Questionnaire
About KUR

For Referrers
The Pathways
The Programme
Treatment
Our Approach
Questionnaire
About KUR

Contact

hello@kurclinic.com
86 Harley Street, 4th Floor
London W1G 7HP
Mon-Fri: 8:30am-8pm
Saturday: 9am-1pm