Physio Self Referral

Patients over 16 years can now self-refer to physiotherapy for muscle and joint problems without needing to see a GP. Please download and print out the form below, you can either return it to us or send it to the address or email at the end of the form.

If you do not have the facility to print, forms are also available to pick up from our reception.

Physiotherapy self referral form – MSKT self referral V4

Please consult your GP URGENTLY or NHS 24 by calling 111 if you have recently/suddenly developed:

› Difficulty passing urine or controlling bladder / bowels

› Numbness or tingling around your back passage or genitals

› Numbness, pins and needles or weakness in both legs

Please inform your GP of this referral if you:

› Have recently become unsteady on your feet

› Are feeling generally unwell / fever

› Have a history of cancer

› Have any unexplained weight loss