Physiotherapy self-referral

Please read this before continuing

Consult your GP or NHS 111 urgently if you have recently or suddenly developed any of the following:

• Difficulty passing urine or controlling bladder/bowels

• Numbness or tingling around the back passage or genitals

• Numbness, pins and needles or weakness in both legs.

Discuss with your GP before submitting a referral if you:

• Are feeling generally unwell or have a fever

• Have any unexplained weight loss

• Have a history of cancer

• Have recently become unsteady on your feet.

Refer yourself for physiotherapy

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Please note that we use Jotform as part of our referral process.

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