Thank you for choosing to complete a physiotherapy self-referral form for East Sussex MSK Community Partnership.
Completing this physiotherapy self-referral will take around 20 minutes.
Please make sure that information you provide is as accurate as possible to ensure you are offered the correct service to help your condition. Some questions are mandatory as indicated by a '*' next to the question.
To complete this form you will need:
By completing this form you consent to East Sussex MSK Community Partnership sharing the information provided with your GP and our physiotherapy providers.
The information that you submit on this form will be reviewed by one of our clinicians. Please be aware we may need to contact you by phone to discuss the information you provide in this form, to ensure you are referred to the most appropriate service for your needs.