MSK Physio self referral

You can refer yourself for physiotherapy without visiting your GP first by downloading the form here.

Please note: If you have any of the following, please see your GP before referring yourself:

  • Changes in your bladder and bowel habits.
  • A hot swollen joint.
  • Constant severe pain and you are unable to find relief.
  • Weakness, pins and needles, loss of feeling.
  • History of cancer

Fill in all the boxes on the second page and either post, email or hand deliver that page to one of the Physiotherapy Departments listed below.

Physiotherapy Departments

Please note these email addresses are for referrals only. Please do not use the email to contact department for any other purpose. Unless an email is encrypted the security of that email cannot be guaranteed.

Who is eligible?

Anyone over 16 years old who has pain or discomfort in their muscles, joints or ligaments. You must be able to attend one of the physio outpatient departments; this form is not for patients who require a home visit.

What happens once the form has been handed in?

Your referral form will be looked at by a Physiotherapist and they will decide whether they can help with your condition.

When the physio department are in a position to offer you an appointment, they will contact you.

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