Pregnancy related pelvic girdle pain and/ or back pain.

This is a self-referral form for pelvic health physiotherapy. This form is for anyone aged 16 and over who is experiencing back or pelvic pain in pregnancy within 3 months of giving birth.  

Self referral is another way of getting to see a pelvic health physiotherapist. It means you don't need to see the GP and wait for them to refer you.

Please note that the self-referral pathway is currently only for patients who are registered with Sydenham Green Group practice, Vale Medical Centre, Wells Park Practice, Woolstone Medical Centre. Please do not attempt to complete the referral if you are registered with another GP as your referral will be rejected.