MSK Physiotherapy

Physiotherapy Self referral is for those patients who wish to refer themselves for physiotherapy.

Please fill in this form as fully as possible. If there are blanks this may delay your appointment as we will have to contact you for more information. A physiotherapist will look at the form and your appointment will be planned based on the information you have supplied.

Depending on the nature of your problem you may be placed on a waiting list for physiotherapy. The waiting time for physiotherapy varies depending on the demands on the service.

You will either be sent a letter asking you to contact the department to arrange an appointment or someone may telephone you to arrange it. Please ensure all your contact details have been included on this form including a day-time telephone number.

We may leave a message on your telephone, please tick the box on the reverse of the form if you do not want us to leave a message.

At present the majority of our initial and follow up consultations are being undertaken by telephone or video consultation. This is likely to be the case for some time. If you are asked to attend an appointment please note that we are adhering to social distancing rules, hand hygiene and infection control procedures. Please do not attend the department if you are feeling unwell or are experiencing any symptoms of COVID-19.

MSK Physiotherapy Self Referral Form